Pulmonary complications post allogeneic haematopoietic stem cell transplant in children.

Autor: Walker H; Children's Cancer Centre Royal Children's Hospital Parkville VIC Australia.; Department of Paediatrics University of Melbourne Parkville VIC Australia.; Murdoch Children's Research Institute Parkville VIC Australia., Abbotsford J; Department of Infectious diseases Perth Children's Hospital Nedlands WA Australia., Haeusler GM; Department of Paediatrics University of Melbourne Parkville VIC Australia.; Murdoch Children's Research Institute Parkville VIC Australia.; Infection Diseases Unit, Department of General Medicine Royal Children's Hospital Parkville VIC Australia.; Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne VIC Australia.; NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology University of Melbourne Parkville VIC Australia.; The Paediatric Integrated Cancer Service Parkville VIC Australia., Yeoh D; Murdoch Children's Research Institute Parkville VIC Australia.; Department of Infectious diseases Perth Children's Hospital Nedlands WA Australia., Ramachandran S; Department of Clinical Haematology, Oncology and Bone Marrow Transplantation Perth Children's Hospital Nedlands WA Australia.; Division of Paediatrics University of Western Australia Medical School Perth WA Australia., Ng M; Department of Clinical Haematology, Oncology and Bone Marrow Transplantation Perth Children's Hospital Nedlands WA Australia., Holzmann J; Department of Clinical Haematology, Oncology and Bone Marrow Transplantation Perth Children's Hospital Nedlands WA Australia., Shanthikumar S; Department of Paediatrics University of Melbourne Parkville VIC Australia.; Murdoch Children's Research Institute Parkville VIC Australia.; Respiratory and Sleep Medicine Royal Children's Hospital Parkville VIC Australia., Weerdenburg H; Children's Cancer Centre Royal Children's Hospital Parkville VIC Australia.; Department of Paediatrics University of Melbourne Parkville VIC Australia.; Murdoch Children's Research Institute Parkville VIC Australia., Hanna D; Children's Cancer Centre Royal Children's Hospital Parkville VIC Australia.; Department of Paediatrics University of Melbourne Parkville VIC Australia.; Murdoch Children's Research Institute Parkville VIC Australia.; The Paediatric Integrated Cancer Service Parkville VIC Australia., Neeland MR; Department of Paediatrics University of Melbourne Parkville VIC Australia.; Murdoch Children's Research Institute Parkville VIC Australia., Cole T; Children's Cancer Centre Royal Children's Hospital Parkville VIC Australia.; Department of Paediatrics University of Melbourne Parkville VIC Australia.; Murdoch Children's Research Institute Parkville VIC Australia.; Allergy and Immunology Royal Children's Hospital Parkville VIC Australia.
Jazyk: angličtina
Zdroj: Clinical & translational immunology [Clin Transl Immunology] 2024 Sep 17; Vol. 13 (9), pp. e70003. Date of Electronic Publication: 2024 Sep 17 (Print Publication: 2024).
DOI: 10.1002/cti2.70003
Abstrakt: Objectives: Haematopoietic stem cell transplant (HCT) is a cellular therapy that, whilst curative for a child's underlying disease, carries significant risk of mortality, including because of pulmonary complications. The aims of this study were to describe the burden of pulmonary complications post-HCT in a cohort of Australian children and identify risk factors for the development of these complications.
Methods: Patients were identified from the HCT databases at two paediatric transplant centres in Australia. Medical records were reviewed, and demographics, HCT characteristics and pulmonary complications documented. Relative risk ratio was used to identify risk factors for developing pulmonary complications prior to first transplant episode, and survival analysis performed to determine hazard ratio.
Results: In total, 243 children underwent transplant during the study period, and pulmonary complications occurred in 48% (117/243) of children. Infectious complications were more common (55%) than non-infective complications (18%) and 26% of patients developed both. Risk factors for the development of pulmonary complications included the following: diagnoses of MPAL (RR 2.16, P  = 0.02), matched unrelated donor (RR1.34, P  = 0.03), peripheral blood (RR 1.36, P  = 0.028) or cord blood (RR 1.73, P  = 0.012) as the stem cell source and pre-existing lung disease (RR1.72, P  < 0.0001). Children with a post-HCT lung complication had a significantly increased risk of mortality compared with those who did not (HR 3.9, P  < 0.0001).
Conclusion: This study demonstrates pulmonary complications continue to occur frequently in children post-HCT and contribute significantly to mortality. Highlighting the need for improved strategies to identify patients at risk pre-transplant and enhanced treatments for those who develop lung disease.
Competing Interests: The authors declare no conflict of interest.
(© 2024 The Author(s). Clinical & Translational Immunology published by John Wiley & Sons Australia, Ltd on behalf of Australian and New Zealand Society for Immunology, Inc.)
Databáze: MEDLINE
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