Late-onset noninfectious pulmonary complications after allogeneic stem cell transplantation are significantly associated with chronic graft-versus-host disease and with the graft-versus-leukemia effect
| Autor: | Ryuko Cho, Akane Harima, Akira Yokota, Chiaki Nakaseko, Emiko Sakaida, Yasushi Saito, Miki Nishimura |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
Lung Diseases Male medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment Immunology Graft vs Host Disease Bronchiolitis obliterans Graft vs Leukemia Effect Hematopoietic stem cell transplantation Biochemistry Gastroenterology Risk Factors Internal medicine Sicca syndrome medicine Humans Transplantation Homologous Retrospective Studies Cause of death business.industry Respiratory disease Hematopoietic Stem Cell Transplantation Cell Biology Hematology Middle Aged medicine.disease Hematologic Diseases Surgery Transplantation Treatment Outcome surgical procedures operative Graft-versus-host disease Chronic Disease Female Complication business |
| Zdroj: | Blood. 102:4236-4242 |
| ISSN: | 1528-0020 0006-4971 |
| Popis: | Late-onset noninfectious pulmonary complications (LONIPCs) occurring beyond 3 months after allogeneic stem cell transplantation (allo-SCT) have become recognized as life-threatening complications, and they reduce the recipient's quality of life. However, the pathogenesis and optimal treatment for LONIPCs are still unclear. In this study, we retrospectively analyzed the incidence and outcome of LONIPCs among allo-SCT recipients. Between October 1993 and September 2001, 96 patients underwent allo-SCT and 76 patients who survived and were free of disease for more than 3 months after SCT were enrolled. Among the 76 patients, 18 patients (23.7%) developed LONIPCs at a median interval of 227 days after allo-SCT (range, 91-1105 days). The patients with LONIPCs were subclassified into those with bronchiolitis obliterans (BO) (6 patients), with interstitial pneumonia (IP) (11 patients), or with both BO and IP (1 patient). The presence of extensive chronic graft-versus-host disease (GVHD) was significantly associated with the development of LONIPCs (P = .0008). Liver or skin involvement in chronic GVHD was not associated, but sicca syndrome was significantly associated with the development of LONIPCs (P < .0001). Most of the IP patients (58.3%) responded well to immunosuppressive treatment, while BO patients did not respond to the therapy. Eight of the 18 patients with LONIPCs died. The major cause of death was respiratory failure (62.5%). The relapse rate of primary malignant disease in the LONIPC patients was significantly lower than that of non-LONIPC patients (1 of 17 [5.9%] versus 16 of 52 [30.8%]; P = .0387). These results indicate that the development of LONIPCs was strongly associated with chronic GVHD and especially with sicca syndrome and the graft-versus-leukemia (GVL) effect. (Blood. 2003;102:4236-4242) |
| Databáze: | OpenAIRE |
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