Dataset Information

Late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation: prognostic factors and treatments.

ABSTRACT:

Background

In this study, we aimed to evaluate the prognostic factors associated with and treatments for late-onset severe pneumonia (LOSP) in patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods

Fifty consecutive patients who underwent non-T-cell-depleted allo-HSCT at the Peking University Institute of Hematology and met the criterion of LOSP after allo-HSCT were enrolled.

Results

The median time from allo-HSCT to the occurrence of LOSP was 231 (90-1487) days. Twenty-eight patients harbored 1 or more pathogens (infectious LOSP, I-LOSP), whereas 22 did not harbor any pathogens (non-infectious LOSP, NI-LOSP). The 100-day survival rate of LOSP patients was 31.1%. Patients smoking before allo-HSCT (0% vs. 35.4%, P = 0.002) and male gender (20.0% vs. 61.9%, P = 0.026) had lower 100-day survival rate. Patients with a lower bronchoalveolar lavage fluid (BALF) neutrophil percentage had higher 100-day survival rate relative to those with higher BALF neutrophil percentage (45.5% vs. 16.7%, P = 0.012). The 100-day survival rate of patients with I-LOSP was lower than that of patients with NI-LOSP (19.1% vs. 46.9%, P = 0.043). Patients given late (?1 week after LOSP diagnosis) and low-dose methylprednisolone (MP) therapy (?2 mg/kg/day) had the best 100-day survival rate. In the multivariate analysis, nonsmoking before allo-HSCT and late and low-dose MP therapy were significantly associated with a better survival after LOSP.

Conclusion

LOSP is a severe complication after allo-HSCT. The correct timing and corticosteroid dosage in the context of broad-spectrum antimicrobial therapy might further improve the outcomes of patients with LOSP.

SUBMITTER: Mo XD

PROVIDER: S-EPMC7169772 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Publications

Late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation: prognostic factors and treatments.

Mo X-D XD Zhang X-H XH Xu L-P LP Wang Y Y Yan C-H CH Chen H H Chen Y-H YH Han W W Wang F-R FR Wang J-Z JZ Liu K-Y KY Huang X-J XJ

Transplant infectious disease : an official journal of the Transplantation Society 20160802 4

<h4>Background</h4>In this study, we aimed to evaluate the prognostic factors associated with and treatments for late-onset severe pneumonia (LOSP) in patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).<h4>Methods</h4>Fifty consecutive patients who underwent non-T-cell-depleted allo-HSCT at the Peking University Institute of Hematology and met the criterion of LOSP after allo-HSCT were enrolled.<h4>Results</h4>The median time from allo-HSCT to the occurrence of ...[more]

PMID: 27218435

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Project description:BackgroundLong-term survivors of allogeneic hematopoietic stem cell transplantation (alloHSCT) are at a substantial risk of developing medical late effects. We aimed to determine the incidence of metabolic syndrome (MS), cardiovascular (CV) events, bone density loss, and fractures in a cohort of patients who underwent alloHSCT for hematologic disorders. The potential risk factors for MS, CV events, bone density loss, and fractures, as well as the sufficiency of existing monitoring measures in our institution, were also evaluated.MethodsA single-center, retrospective study was conducted. We included patients who underwent alloHSCT at the Singapore General Hospital between January 2011 and December 2016, were at least 21 years old, and had a minimum follow-up period of 6 months. Patients with MS-related data comprised the CV study population, whereas patients with bone loss-related data comprised the skeletal study population. Associations between risk factors and the development of MS or bone loss were assessed using a univariate analysis followed by multivariate logistic regression. All analyses were performed using SPSS version 23.ResultsA total of 91 patients were included in the CV study population, of which 13 (14.3%) had preexisting MS, 17 (18.7%) developed MS, and 5 (5.5%) developed CV events after alloHSCT. Thirty-one patients were included in the skeletal study population, of which 2 (6.5%) had preexisting bone loss, 23 (71.0%) developed osteopenia or osteoporosis, and 2 (6.5%) had a fracture. After adjusting for preexisting MS, pretransplant abdominal obesity (p=0.002), elevated triglyceride (p<0.001), and fasting hyperglycemia (p<0.001) significantly predicted MS on multivariate analyses. Only female sex predicted the risk of bone loss after alloHSCT on multivariate analyses after adjusting for preexisting osteopenia (p=0.02). Of the 174 patients who underwent alloHSCT during the study period, 83 (47.7%) and 143 (82.2%) patients had no MS-related data and bone loss-related data, respectively.ConclusionLong-term alloHSCT survivors are at an increased risk of MS, CV complications, and bone loss. This underscores the importance of close monitoring and timely interventions to reduce long-term morbidity and mortality.

Project description:IMPORTANCE:Myeloablative allogeneic hematopoietic stem cell transplantation (HSCT) is curative for children with severe sickle cell disease, but toxicity may be prohibitive for adults. Nonmyeloablative transplantation has been attempted with degrees of preparative regimen intensity, but graft rejection and graft-vs-host disease remain significant. OBJECTIVE:To determine the efficacy, safety, and outcome on end-organ function with this low-intensity regimen for sickle cell phenotype with or without thalassemia. DESIGN, SETTING, AND PARTICIPANTS:From July 16, 2004, to October 25, 2013, 30 patients aged 16-65 years with severe disease enrolled in this nonmyeloablative transplant study, consisting of alemtuzumab (1 mg/kg in divided doses), total-body irradiation (300 cGy), sirolimus, and infusion of unmanipulated filgrastim mobilized peripheral blood stem cells (5.5-31.7?×?10(6) cells/kg) from human leukocyte antigen-matched siblings. MAIN OUTCOMES AND MEASURES:The primary end point was treatment success at 1 year after the transplant, defined as a full donor-type hemoglobin for patients with sickle cell disease and transfusion independence for patients with thalassemia. The secondary end points were the level of donor leukocyte chimerism; incidence of acute and chronic graft-vs-host disease; and sickle cell-thalassemia disease-free survival, immunologic recovery, and changes in organ function, assessed by annual brain imaging, pulmonary function, echocardiographic image, and laboratory testing. RESULTS:Twenty-nine patients survived a median 3.4 years (range, 1-8.6), with no nonrelapse mortality. One patient died from intracranial bleeding after relapse. As of October 25, 2013, 26 patients (87%) had long-term stable donor engraftment without acute or chronic graft-vs-host disease. The mean donor T-cell level was 48% (95% CI, 34%-62%); the myeloid chimerism levels, 86% (95% CI, 70%-100%). Fifteen engrafted patients discontinued immunosuppression medication with continued stable donor chimerism and no graft-vs-host disease. The normalized hemoglobin and resolution of hemolysis among engrafted patients were accompanied by stabilization in brain imaging, a reduction of echocardiographic estimates of pulmonary pressure, and allowed for phlebotomy to reduce hepatic iron. The mean annual hospitalization rate was 3.23 (95% CI, 1.83-4.63) the year before, 0.63 (95% CI, 0.26-1.01) the first year after, 0.19 (95% CI, 0-0.45) the second year after, and 0.11 (95% CI, 0.04-0.19) the third year after transplant. For patients taking long-term narcotics, the mean use per week was 639 mg (95% CI, 220-1058) of intravenous morphine-equivalent dose the week of their transplants and 140 mg (95% CI, 56-225) 6 months after transplant. There were 38 serious adverse events: pain and related management, infections, abdominal events, and sirolimus related toxic effects. CONCLUSIONS AND RELEVANCE:Among 30 patients with sickle cell phenotype with or without thalassemia who underwent nonmyeloablative allogeneic HSCT, the rate of stable mixed-donor chimerism was high and allowed for complete replacement with circulating donor red blood cells among engrafted participants. Further accrual and follow-up are required to assess longer-term clinical outcomes, adverse events, and transplant tolerance. TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT00061568.

Dataset Information

Late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation: prognostic factors and treatments.

Background

Methods

Results

Conclusion

Publications

Late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation: prognostic factors and treatments.

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