28.01.2022 | Original Article
Risk factors and prognosis of non-infectious pulmonary complications after allogeneic hematopoietic stem cell transplantation
verfasst von:
Makoto Onizuka, Nobuharu Fujii, Hideki Nakasone, Masao Ogata, Yoshiko Atsuta, Ritsuro Suzuki, Naoyuki Uchida, Kazuteru Ohashi, Yukiyasu Ozawa, Tetsuya Eto, Kazuhiro Ikegame, Hirohisa Nakamae, Masami Inoue, Takahiro Fukuda, for the Transplant Complications Working Group of the Japan Society for Hematopoietic Cell Transplantation
Erschienen in:
International Journal of Hematology
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Ausgabe 4/2022
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Abstract
Non-infectious pulmonary complications (NIPCs) following allogeneic hematopoietic stem cell transplantation (HSCT) are relatively rare, but frequently fatal. This study investigated the pre-transplant risk factors for developing NIPCs using Japanese transplant registry database entries from 2001 to 2009. Among 13,573 eligible patients, 535 experienced NIPCs (3.9%). Multivariate analysis identified high recipient age (60 + years: HR 1.85, P = 0.003), HLA mismatch (HR 1.61, P < 0.001), female to male HSCT (HR 1.54, P < 0.001), and unrelated bone marrow transplantation (UR-BMT) (HR 3.88, P < 0.001) as significantly associated with an increased risk of NIPCs. In contrast, a non-total body irradiation (TBI) regimen with reduced intensity conditioning (RIC) were associated with a decreased risk of NIPCs compared with a cyclophosphamide (CY) + TBI regimen (busulfan + CY: HR 0.67, P = 0.009, other non-TBI: HR 0.46, P < 0.001), fludarabine-based RIC (HR 0.52, P < 0.001), and other RIC (HR 0.42, P = 0.003). The mortality rate was significantly worse for patients with NIPCs than those without (HR 1.54, 71 P < 0.001). This large-scale retrospective study suggests that both allo-reactions to donor cells and conditioning regimen toxicity contributed to NIPCs following HSCT.