1
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[Chinese expert consensus on the management of long-term complications after hematopoietic stem cell transplantation (2023)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:717-722. [PMID: 38049314 PMCID: PMC10630577 DOI: 10.3760/cma.j.issn.0253-2727.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Indexed: 12/06/2023]
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2
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Busmail A, Penumetcha SS, Ahluwalia S, Irfan R, Khan SA, Rohit Reddy S, Vasquez Lopez ME, Zahid M, Mohammed L. A Systematic Review on Pulmonary Complications Secondary to Hematopoietic Stem Cell Transplantation. Cureus 2022; 14:e24807. [PMID: 35686267 PMCID: PMC9170423 DOI: 10.7759/cureus.24807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 05/07/2022] [Indexed: 11/15/2022] Open
Abstract
The main purpose of this systematic review was to identify and synthesize evidence about pulmonary complications following stem cell transplantation to raise awareness among physicians since it is a lesser-known topic. Studies that included targeted pulmonary complications that occurred after stem cell transplantation; in humans; and were randomized controlled trials, cohort studies, and case studies between January 2011 and 2021. Fifteen intervention features were identified and analyzed in terms of their association with successful or unsuccessful interventions. Fifteen of 15 studies that met inclusion criteria had positive results. Features that appeared to have the most consistent positive effects included relevant information consisting of clinical presentations and management of complications. Hematopoietic stem cell transplantation is a therapeutic method that has been introduced for various hematological diseases. Its main objective is to restore the hematopoietic function that has been eradicated or affected. The stem cell transplantation requires a period of administration of chemotherapeutic agents that may lead to infectious and/or non-infectious pulmonary complications that require follow-up. Noninfectious pulmonary complications include bronchiolitis obliterans, alveolar hemorrhage, fibroelastosis, pulmonary hypertension, and infections. Bronchiolitis obliterans syndrome is an obstructive lung disease that affects the small airways, reducing lung function, and it’s the most frequent late-onset complication. Furthermore, diffuse pulmonary hemorrhage is a fatal adverse effect and the most common noninfectious pulmonary complication of acute leukemia, observed within the first weeks after the procedure. Pulmonary hypertension has multiple etiologies, mainly related to the pulmonary veno-occlusive disease. It carries a poor prognosis, with a 55% mortality rate. The area of hematology is very wide and prone to new development of treatments and procedures that could be available for new emerging diseases and improving survival rates.
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3
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Jamani K, He Q, Liu Y, Davis C, Hubbard J, Schoch G, Lee SJ, Gooley T, Flowers MED, Cheng GS. Early Post-Transplantation Spirometry Is Associated with the Development of Bronchiolitis Obliterans Syndrome after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 26:943-948. [PMID: 31821885 DOI: 10.1016/j.bbmt.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 12/11/2022]
Abstract
Bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (allo-HCT) is often diagnosed at a late stage when lung dysfunction is severe and irreversible. Identifying patients early after transplantation may offer improved strategies for early detection that could avert the morbidity and mortality of BOS. This study aimed to determine whether a decline in lung function before and early after (days +80 to +100) allo-HCT are associated with a risk of BOS beyond 6 months post-transplantation. In a single-center cohort of 2941 allo-HCT recipients, 186 (6%) met National Institutes of Health criteria for BOS. Pretransplantation and post-transplantation day +80 spirometric parameters were analyzed as continuous variables and included in a multivariable model with other factors, including donor source, graft source, conditioning regimen, use of total body irradiation, and immunoglobulin levels. Pre-transplantation forced expiratory flow between 25% and 75% of maximum (FEF25-75), day +80 forced expiratory volume in 1 second (FEV1), and day +80 FEF25-75 had the strongest associations with increased risk of BOS. Assessment of the multivariable model showed that a decline in day +80 FEF25-75 added additional risk to the day +80 FEV1 model (P = .03), whereas FEV1 decline at day +80 added no additional risk to the day +80 FEF25-75 model (P = .645). Moreover, day +80 FEF25-75 conferred additional risk when considered with pretransplantation FEF25-75. These results suggest that day +80 FEF25-75 may be more important than FEV1 in predicting the development of BOS. This study highlights the importance of obtaining early post-transplantation pulmonary function tests for the potential risk stratification of patients at risk for BOS.
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Affiliation(s)
- Kareem Jamani
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Qianchuan He
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yang Liu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Chris Davis
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jesse Hubbard
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Gary Schoch
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Hematology and Oncology, University of Washington, Seattle, Washington
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Hematology and Oncology, University of Washington, Seattle, Washington
| | - Guang-Shing Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington.
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4
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Liu YC, Chou YH, Ko PS, Wang HY, Fan NW, Liu CJ, Hsiao LT, Chien SH, Chiou TJ, Liu JH, Gau JP. Risk factors and clinical features for post-transplant thoracic air-leak syndrome in adult patients receiving allogeneic haematopoietic stem cell transplantation. Sci Rep 2019; 9:11795. [PMID: 31409884 PMCID: PMC6692350 DOI: 10.1038/s41598-019-48308-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/22/2019] [Indexed: 12/26/2022] Open
Abstract
Post-transplant thoracic air-leak syndrome (ALS) is rare but potentially life-threatening in patients receiving allogeneic haematopoietic stem cell transplantation (HSCT). Nevertheless, papers on thoracic ALS are limited, and this complication remains largely unknown. We reviewed 423 adult patients undergoing allogeneic HSCT from 2003 to 2014. Risk factors, clinical features and survival for thoracic ALS were collected and analysed. Thirteen out of 423 patients (3.1%) developed post-transplant thoracic ALS, including two ALS patients in the early phase. The median age at HSCT was 33 years among 13 patients with thoracic ALS. Male patients were predominant (69%). The median onset time was 253 days (range: 40–2680) after HSCT. Multivariate analysis revealed that grade III–IV acute graft-versus-host disease (GVHD) (p = 0.017), extensive chronic GVHD (cGVHD) (p = 0.019) and prior history of pulmonary invasive fungal infection (p = 0.007) were significant risk factors for thoracic ALS. In patients with cGVHD, those with thoracic ALS had a significantly worse survival than those without thoracic ALS (p = 0.04). Currently, published data analysing and exploring post-transplant thoracic ALS are limited. Our study employed a large patient cohort and determined the risk factors and clinical features for post-transplant thoracic ALS.
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Affiliation(s)
- Yao-Chung Liu
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yi-Hsin Chou
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Shen Ko
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Yuan Wang
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Wen Fan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Hsuan Chien
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Hwang Liu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Haematology and Oncology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jyh-Pyng Gau
- Division of Haematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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5
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Barisione G, Dominietto A, Bianchi R, Garlaschi A, Bacigalupo A, Stellino L, Brusasco V. Trajectory of lung function to pleuroparenchymal fibroelastosis late after haematopoietic stem-cell transplantation. Respir Med Case Rep 2019; 28:100915. [PMID: 31388483 PMCID: PMC6675970 DOI: 10.1016/j.rmcr.2019.100915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/28/2022] Open
Abstract
Pleuroparenchymal fibroelastosis is characterized by upper lobes subpleural intra-alveolar fibrosis and elastosis with visceral pleural fibrosis, which may occur after allogenic haematopoietic stem-cell transplantation (HSCT). The longitudinal changes of lung function preceding this complication have not been described. We report the case of an adult woman undergoing allogeneic HSCT for Hodgkin's lymphoma. Pulmonary function tests evolved from normal, before transplantation, to a restrictive pattern with normal residual volume 3 months after transplantation, then to an obstructive pattern consistent with bronchiolitis obliterans 18 months after transplantation, and finally to a severe mixed pattern with preserved residual volume. Computed tomography showed the distinctive features of pleuroparenchymal fibroelastosis, confirmed by histology of specimen from apical resection after pneumothorax. This case report suggests that pleuroparenchymal fibroelastosis may occur after HSCT following bronchiolitis obliterans syndrome with a mixed (restrictive-obstructive) lung function pattern.
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Affiliation(s)
- Giovanni Barisione
- S.S. Fisiopatologia Respiratoria, Clinica Malattie Respiratorie e Allergologia, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Alida Dominietto
- U.O. Ematologia, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Rita Bianchi
- Dipartimento della Diagnostica di Laboratorio, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Alessandro Garlaschi
- Dipartimento della Diagnostica per Immagini e Radioterapia, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Andrea Bacigalupo
- U.O. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Lorenzo Stellino
- S.S. Fisiopatologia Respiratoria, Clinica Malattie Respiratorie e Allergologia, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Vito Brusasco
- S.S. Fisiopatologia Respiratoria, Clinica Malattie Respiratorie e Allergologia, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
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6
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Ghimire S, Weber D, Mavin E, Wang XN, Dickinson AM, Holler E. Pathophysiology of GvHD and Other HSCT-Related Major Complications. Front Immunol 2017; 8:79. [PMID: 28373870 PMCID: PMC5357769 DOI: 10.3389/fimmu.2017.00079] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 01/17/2017] [Indexed: 12/13/2022] Open
Abstract
For over 60 years, hematopoietic stem cell transplantation has been the major curative therapy for several hematological and genetic disorders, but its efficacy is limited by the secondary disease called graft versus host disease (GvHD). Huge advances have been made in successful transplantation in order to improve patient quality of life, and yet, complete success is hard to achieve. This review assimilates recent updates on pathophysiology of GvHD, prophylaxis and treatment of GvHD-related complications, and advances in the potential treatment of GvHD.
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Affiliation(s)
- Sakhila Ghimire
- Department of Internal Medicine III, University Medical Centre , Regensburg , Germany
| | - Daniela Weber
- Department of Internal Medicine III, University Medical Centre , Regensburg , Germany
| | - Emily Mavin
- Hematological Sciences, Institute of Cellular Medicine, Newcastle University , Newcastle , UK
| | - Xiao Nong Wang
- Hematological Sciences, Institute of Cellular Medicine, Newcastle University , Newcastle , UK
| | - Anne Mary Dickinson
- Hematological Sciences, Institute of Cellular Medicine, Newcastle University , Newcastle , UK
| | - Ernst Holler
- Department of Internal Medicine III, University Medical Centre , Regensburg , Germany
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7
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Clavert A, Peric Z, Brissot E, Malard F, Guillaume T, Delaunay J, Dubruille V, Le Gouill S, Mahe B, Gastinne T, Blin N, Harousseau JL, Moreau P, Milpied N, Mohty M, Chevallier P. Late Complications and Quality of Life after Reduced-Intensity Conditioning Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2017; 23:140-146. [DOI: 10.1016/j.bbmt.2016.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/12/2016] [Indexed: 12/14/2022]
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8
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Pulmonary function after hematopoietic stem cell transplantation is significantly better in pediatric recipients following reduced toxicity compared with myeloablative conditioning. Bone Marrow Transplant 2016; 51:1530-1532. [PMID: 27322849 DOI: 10.1038/bmt.2016.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Gorospe Sarasúa L, Barrios-Barreto D, García Gómez-Muriel I, Chinea-Rodríguez A. Bronchiolitis obliterans following hematopoietic stem cell transplantation: Importance of expiratory computed tomography. Arch Bronconeumol 2016; 53:349-351. [PMID: 27745931 DOI: 10.1016/j.arbres.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/30/2016] [Accepted: 09/05/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Luis Gorospe Sarasúa
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España.
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10
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Fedele R, Salooja N, Martino M. Recommended screening and preventive evaluation practices of adult candidates for hematopoietic stem cell transplantation. Expert Opin Biol Ther 2016; 16:1361-1372. [DOI: 10.1080/14712598.2016.1229773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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11
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What do we need to know about allogeneic hematopoietic stem cell transplant survivors? Bone Marrow Transplant 2016; 51:1025-31. [PMID: 27064688 DOI: 10.1038/bmt.2016.95] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 12/22/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for over 70 benign and malignant hematologic and immunological processes. Over the past several decades, significant technological and post-transplant supportive advances have been made, resulting in a decrease in early transplant mortality and continued growth in the population of allo-HSCT survivors. With the expansion in the number of long-term survivors, as well as of those considering a transplant, the focus of transplant medicine has been shifted significantly to include a more prominent role for the care of the 'long-term' survivor. These patients have survived the acute critical phase of transplantation and have potentially achieved remission from their primary disease, yet allo-HSCT patients do not return to pre-transplant health status. For survivors >2 years removed, the time of transplant all-cause mortality is four- to nine-fold higher than age-matched peers within the general population. These patients represent a distinct, high-risk population that must be monitored for long-term transplant complications, including chronic GvHD (cGvHD), multi-organ dysfunctions and secondary malignancies. This article will review in a non-exhaustive manner, the approach to long-term care of an allo-HSCT recipient.
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12
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Hematopoietic Stem Cell Transplantation. PATHOLOGY OF TRANSPLANTATION 2016. [PMCID: PMC7124099 DOI: 10.1007/978-3-319-29683-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Oh AL, Patel P, Sweiss K, Chowdhery R, Dudek S, Rondelli D. Decreased pulmonary function in asymptomatic long-term survivors after allogeneic hematopoietic stem cell transplant. Bone Marrow Transplant 2015; 51:283-5. [PMID: 26437068 DOI: 10.1038/bmt.2015.216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A L Oh
- Division of Hematology/ Oncology, University of Illinois Hospital and Health Science System, Chicago, IL, USA
| | - P Patel
- Division of Hematology/ Oncology, University of Illinois Hospital and Health Science System, Chicago, IL, USA.,University of Illinois Cancer Center, Chicago, IL, USA
| | - K Sweiss
- Department of Pharmacy Practice, University of Illinois Hospital and Health Science System, Chicago, IL, USA
| | - R Chowdhery
- Division of Hematology/ Oncology, University of Illinois Hospital and Health Science System, Chicago, IL, USA
| | - S Dudek
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Hospital and Health Science System, Chicago, IL, USA
| | - D Rondelli
- Division of Hematology/ Oncology, University of Illinois Hospital and Health Science System, Chicago, IL, USA.,University of Illinois Cancer Center, Chicago, IL, USA
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14
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Bergeron A, Chevret S, Chagnon K, Godet C, Bergot E, Peffault de Latour R, Dominique S, de Revel T, Juvin K, Maillard N, Reman O, Contentin N, Robin M, Buzyn A, Socié G, Tazi A. Budesonide/Formoterol for Bronchiolitis Obliterans after Hematopoietic Stem Cell Transplantation. Am J Respir Crit Care Med 2015; 191:1242-9. [DOI: 10.1164/rccm.201410-1818oc] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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15
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Jose RJ, Faiz SA, Dickey BF, Brown JS. Non-infectious respiratory disease in non-HIV immunocompromised patients. Br J Hosp Med (Lond) 2015; 75:691-7. [PMID: 25488532 DOI: 10.12968/hmed.2014.75.12.691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This review summarizes current knowledge regarding frequently encountered non-infectious respiratory complications in adult immunocompromised hosts (excluding those with human immunodeficiency virus (HIV) infection). In particular it will discuss complications of transplantation and of primary immunodeficiencies.
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Affiliation(s)
- Ricardo J Jose
- Wellcome Trust Clinical Research Fellow in the Centre for Inflammation and Tissue Repair, University College London and Honorary Specialist Registrar, Department of Thoracic Medicine, University College London Hospital, London WC1E 6JF
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16
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Pulmonary Manifestations of Hematological Malignancies: Focus on Pulmonary Chronic Graft-Versus Host Disease. ORPHAN LUNG DISEASES 2015. [PMCID: PMC7120310 DOI: 10.1007/978-1-4471-2401-6_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Advances in the management of patients in terms of the diagnosis and treatment of hematologic malignancies and treatment-related complications, especially infectious complications, have increased survival time. However, more than half of the patients treated for hematologic malignancies will develop a pulmonary complication during their follow-up, infectious pneumonia remaining the most common diagnosis that should be considered first in regard to its potential severity. Otherwise, new complications that may involve different organs, including the lungs, have been increasingly reported. Currently, over a quarter of lung infiltrates occurring in the context of hematological diseases are due to noninfectious causes. Thus, lung physicians may be increasingly confronted with these lung disorders. Various noninfectious pulmonary complications have been described in the different hematological malignancies; however, these complications are most often studied in the context of allogeneic hematopoietic stem cell transplantation (HSCT). In this chapter, we will briefly review the lung diseases associated with various hematological malignancies before focusing on noninfectious pulmonary complications following allogeneic HSCT.
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17
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Bhatia S. Caring for the long-term survivor after allogeneic stem cell transplantation. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:495-503. [PMID: 25696900 DOI: 10.1182/asheducation-2014.1.495] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Survivors of allogeneic hematopoietic cell transplantation (HCT) are at risk of developing long-term complications such as subsequent malignancies and cardiopulmonary compromise. The prevalence of chronic health conditions approaches 75% among allogeneic HCT survivors and that for severe or life-threatening conditions exceeds 20%. This chapter describes the burden of morbidity carried by HCT survivors to help healthcare providers and policy makers understand the scope of the problem and the need for life-long follow-up and proactive care for this vulnerable population.
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Affiliation(s)
- Smita Bhatia
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA
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18
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Tewari P, Franklin AR, Tarek N, Askins MA, Mofield S, Kebriaei P. Hematopoietic stem cell transplantation in adolescents and young adults. Acta Haematol 2014; 132:313-25. [PMID: 25228557 DOI: 10.1159/000360211] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) are a very unique subset of our population journeying through a dynamic stage of their lives. This age group often remains understudied as a separate entity because they are commonly lumped into either pediatric or adult subgroups. METHODS Here we review acute and chronic issues surrounding hematopoietic stem cell transplantation (HSCT) with a focus on the AYA age group. RESULTS HSCT is a commonly used treatment modality for patients with certain types of cancers. AYA patients undergoing HSCT present a very unique perspective, circumstances, medical, psychological and social issues requiring a diligent workup, care and follow-up. CONCLUSION The medical care of these patients should be approached in a multidisciplinary method involving the patient, caregivers, physicians, psychologists and social workers.
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19
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Inamoto Y, Martin PJ, Storer BE, Palmer J, Weisdorf DJ, Pidala J, Flowers MED, Arora M, Jagasia M, Arai S, Chai X, Pavletic SZ, Vogelsang GB, Lee SJ. Association of severity of organ involvement with mortality and recurrent malignancy in patients with chronic graft-versus-host disease. Haematologica 2014; 99:1618-23. [PMID: 24997150 DOI: 10.3324/haematol.2014.109611] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The National Institutes of Health global score for chronic graft-versus-host disease was devised by experts but was not based on empirical data. We hypothesized that analysis of prospectively collected data would enable derivation of a more accurate model for estimating mortality risk. We analyzed 574 adult patients with chronic graft-versus-host disease enrolled in a multicenter, observational study, using multivariate time-varying analysis accounting for serial changes in severity of involvement of eight individual organ sites over time. In the training set, severity of skin, mouth, gastrointestinal tract, liver and lung involvement were independently associated with the risk of non-relapse mortality. Weighted mortality points were assigned to individual organs based on the hazard ratios and were summed. The population was divided into three risk groups based on the total mortality points. The three new risk groups were validated in an independent validation set, but did not show better discriminative performance than the National Institutes of Health global score. As compared to a moderate or mild global score, a severe global score was associated with increased risks of non-relapse and overall mortality across time but not with a decreased risk of recurrent malignancy. The National Institutes of Health global score predicts patients' mortality risk throughout the course of their chronic graft-versus-host disease. Further research is required in order to improve outcomes in patients with severe chronic graft-versus-host disease, since their risk of mortality remains elevated.
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Affiliation(s)
- Yoshihiro Inamoto
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Barry E Storer
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jeanne Palmer
- Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Daniel J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Pidala
- Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mukta Arora
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - Madan Jagasia
- Hematology and Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sally Arai
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA, USA
| | - Xiaoyu Chai
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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20
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Stable long-term pulmonary function after fludarabine, antithymocyte globulin and i.v. BU for reduced-intensity conditioning allogeneic SCT. Bone Marrow Transplant 2014; 49:622-7. [PMID: 24535125 DOI: 10.1038/bmt.2014.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/13/2013] [Accepted: 09/13/2013] [Indexed: 01/22/2023]
Abstract
Lung function decline is a well-recognized complication following allogeneic SCT (allo-SCT). Reduced-intensity conditioning (RIC) and in vivo T-cell depletion by administration of antithymocyte globulin (ATG) may have a protective role in the occurrence of late pulmonary complications. This retrospective study reported the evolution of lung function parameters within the first 2 years after allo-SCT in a population receiving the same RIC regimen that included fludarabine and i.v. BU in combination with low-dose ATG. The median follow-up was 35.2 months. With a median age of 59 years at the time of transplant, at 2 years, the cumulative incidences of non-relapse mortality was as low as 9.7%. The cumulative incidence of relapse was 33%. At 2 years, the cumulative incidences of extensive chronic GVHD (cGVHD) and of pulmonary cGVHD were 23.1% and 1.9%, respectively. The cumulative incidences of airflow obstruction and restrictive pattern were 3.8% and 9.6%, respectively. Moreover, forced expiratory volume (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio remained stable from baseline up to 2 years post transplantation (P=0.26, P=0.27 and P=0.07, respectively). These results correspond favorably with the results obtained with other RIC regimens not incorporating ATG, and suggest that ATG may have a protective pulmonary role after allo-SCT.
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21
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NHANES III equations enhance early detection and mortality prediction of bronchiolitis obliterans syndrome after hematopoietic SCT. Bone Marrow Transplant 2014; 49:561-6. [PMID: 24419526 DOI: 10.1038/bmt.2013.222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/25/2013] [Accepted: 10/31/2013] [Indexed: 02/07/2023]
Abstract
Bronchiolitis obliterans syndrome (BOS) is a serious complication of chronic GVHD (cGVHD) following HSCT (hematopoietic SCT). The clinical diagnosis of BOS is based on pulmonary function test (PFT) abnormalities including: FEV1<75% predicted and obstructive FEV1/VC ratio, calculated using reference equations. We sought to determine if the frequency of clinical diagnoses and severity of BOS would be altered by using the recommended NHANES III vs older equations (Morris/Goldman/Bates, MGB) in 166 cGVHD patients, median age 48 (range: 12-67). We found that NHANES III equations significantly increased the prevalence of BOS, with an additional 11% (18/166) meeting diagnostic criteria by revealing low FEV1 (<75%) (P<0.0001), and six additional patients by obstructive ratio (vs MBG). Collectively, this led to an increase of BOS incidence from 17 (29/166) to 29% (41/166). For patients with severe BOS, (FEV1<35%), NHANES III equations correctly predicted death 71.4% vs 50% using MGB. In conclusion, the use of NHANES III equations markedly increases the proportion of cases meeting diagnostic criteria for BOS and improves prediction of survival.
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22
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Jain NA, Pophali PA, Klotz JK, Ito S, Koklanaris E, Chawla K, Hourigan CS, Gormley N, Savani BN, Barrett AJ, Battiwalla M. Repair of impaired pulmonary function is possible in very-long-term allogeneic stem cell transplantation survivors. Biol Blood Marrow Transplant 2013; 20:209-13. [PMID: 24188917 DOI: 10.1016/j.bbmt.2013.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
Both early- and late-onset noninfectious pulmonary injury are important contributors to the nonrelapse mortality seen after allogeneic stem cell transplantation (allo-SCT), particularly in subjects conditioned with high-dose total body irradiation (TBI). To characterize the kinetics of recovery from pulmonary injury in long-term survivors, we collected data on 138 subjects who survived > 3 years (median survival, 10.2 years) after predominantly TBI-based allo-SCT from their HLA-matched siblings. Baseline pulmonary function tests served as the reference for subsequent measurements at 3, 5, 10, and 15 years for each survivor. The only parameter showing a clinically and statistically significant decline post-transplant was adjusted diffusion capacity of lung for carbon monoxide (DLCO), which reached a nadir at 5 years but surprisingly normalized at the 10-year mark. Multivariable modeling identified chronic graft-versus-host disease (P < .02) and abnormal baseline-adjusted DLCO (P < .03) as the only significant factors associated with the decline in adjusted DLCO at 5 years but excluded smoking, conditioning intensity, baseline C-reactive protein level, TBI dose to the lungs, disease, and demographic variables. In conclusion, pulmonary injury as monitored by the adjusted DLCO continues to deteriorate in the first 5 years after allo-SCT but recovers at 10 years.
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Affiliation(s)
- Natasha A Jain
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Priyanka A Pophali
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey K Klotz
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sawa Ito
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Eleftheria Koklanaris
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kamna Chawla
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Christopher S Hourigan
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nicole Gormley
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Austin John Barrett
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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23
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Kontoyiannis DP. Rational approach to pulmonary infiltrates in leukemia and transplantation. Best Pract Res Clin Haematol 2013; 26:301-6. [PMID: 24309535 DOI: 10.1016/j.beha.2013.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
At present, a number of invasive diagnostic techniques can be used to diagnose the cause of lung infiltrates in patients with hematologic malignancies or hematopoietic stem cell transplantation recipients. Bronchoscopy with measurement of biomarkers in the bronchoalveolar lavage (BAL) will most likely become the preferred method to diagnose infectious causes of pulmonary infiltrates. However, there is no uniform approach regarding the technical parameters of the lavage procedure in cancer patients. Diagnostic protocols vary by region, center, and the expertise of the staff. This mini review discusses the issues surrounding diffuse pulmonary infiltrates and provides some recommendations to deal with these issues.
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Affiliation(s)
- Dimitrios P Kontoyiannis
- Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Unit 1463, 1400 Pressler Street, Houston, TX 77030, USA.
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24
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Lockridge JL, Zhou Y, Becker YA, Ma S, Kenney SC, Hematti P, Capitini CM, Burlingham WJ, Gendron-Fitzpatrick A, Gumperz JE. Mice engrafted with human fetal thymic tissue and hematopoietic stem cells develop pathology resembling chronic graft-versus-host disease. Biol Blood Marrow Transplant 2013; 19:1310-22. [PMID: 23806772 PMCID: PMC3755109 DOI: 10.1016/j.bbmt.2013.06.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 06/10/2013] [Indexed: 12/12/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) is a significant roadblock to long-term hematopoietic stem cell (HSC) transplantation success. Effective treatments for cGVHD have been difficult to develop, in part because of a paucity of animal models that recapitulate the multiorgan pathologies observed in clinical cGVHD. Here we present an analysis of the pathology that occurs in immunodeficient mice engrafted with human fetal HSCs and implanted with fragments of human fetal thymus and liver. Starting at time points generally later than 100 days post-transplantation, the mice developed signs of illness, including multiorgan cellular infiltrates containing human T cells, B cells, and macrophages; fibrosis in sites such as lungs and liver; and thickened skin with alopecia. Experimental manipulations that delayed or reduced the efficiency of the HSC engraftment did not affect the timing or progression of disease manifestations, suggesting that pathology in this model is driven more by factors associated with the engrafted human thymic organoid. Disease progression was typically accompanied by extensive fibrosis and degradation of the thymic organoid, and there was an inverse correlation of disease severity with the frequency of FoxP3(+) thymocytes. Hence, the human thymic tissue may contribute T cells with pathogenic potential, but the generation of regulatory T cells in the thymic organoid may help to control these cells before pathology resembling cGVHD eventually develops. This model thus provides a new system to investigate disease pathophysiology relating to human thymic events and to evaluate treatment strategies to combat multiorgan fibrotic pathology produced by human immune cells.
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Affiliation(s)
- Jennifer L. Lockridge
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706
| | - Ying Zhou
- Department of Transplantation Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792
| | - Yusof A. Becker
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706
| | - Shidong Ma
- Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706
| | - Shannon C. Kenney
- Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706
| | - Peiman Hematti
- Department of Medicine and Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Christian M. Capitini
- Department of Pediatrics and Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - William J. Burlingham
- Department of Transplantation Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792
| | - Annette Gendron-Fitzpatrick
- Comparative Pathology Laboratory, Research Animal Resources Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726
| | - Jenny E. Gumperz
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706
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25
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Histologic findings in lung biopsies in patients with suspected graft-versus-host disease. Hum Pathol 2013; 44:1233-40. [DOI: 10.1016/j.humpath.2012.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/25/2012] [Accepted: 11/28/2012] [Indexed: 11/19/2022]
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26
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Nakasone H, Kanda J, Yano S, Atsuta Y, Ago H, Fukuda T, Kakihana K, Adachi T, Yujiri T, Taniguchi S, Taguchi J, Morishima Y, Nagamura T, Sakamaki H, Mori T, Murata M. A case-control study of bronchiolitis obliterans syndrome following allogeneic hematopoietic stem cell transplantation. Transpl Int 2013; 26:631-9. [DOI: 10.1111/tri.12093] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/05/2013] [Accepted: 02/23/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Hideki Nakasone
- Division of Hematology; Saitama Medical Center; Jichi Medical University; Saitama; Japan
| | - Junya Kanda
- Division of Hematology; Saitama Medical Center; Jichi Medical University; Saitama; Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology; Department of Internal Medicine; Jikei University School of Medicine; Tokyo; Japan
| | - Yoshiko Atsuta
- Department of HSCT Data Management/Biostatistics; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Hiroatsu Ago
- Department of Hematology and Oncology; Shimane Prefectural Central Hospital; Shimane; Japan
| | - Takahiro Fukuda
- Division of Hematopoietic Stem Cell Transplantation; National Cancer Center Hospital; Tokyo; Japan
| | - Kazuhiko Kakihana
- Hematology Division; Tokyo Metropolitan Cancer and Infectious Disease Center; Komagome Hospital; Tokyo; Japan
| | - Tatsuya Adachi
- Department of Hematology; Meitetsu Hospital; Nagoya; Japan
| | - Toshiaki Yujiri
- Third Department of Internal Medicine; Yamaguchi University School of Medicine; Yamaguchi; Japan
| | | | - Jun Taguchi
- Department of Hematology; Atomic Bomb Disease Institute; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki; Japan
| | - Yasuo Morishima
- Division of Epidemiology and Prevention; Aichi Cancer Center Research Institute; Nagoya; Japan
| | - Tokiko Nagamura
- Department of Cell Processing and Transfusion; Institute of Medical Science; University of Tokyo; Tokyo; Japan
| | - Hisashi Sakamaki
- Hematology Division; Tokyo Metropolitan Cancer and Infectious Disease Center; Komagome Hospital; Tokyo; Japan
| | - Takehiko Mori
- Division of Hematology; Department of Medicine; Keio University School of Medicine; Tokyo; Japan
| | - Makoto Murata
- Department of Hematology and Oncology; Nagoya University Graduate School of Medicine; Nagoya; Japan
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27
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Diab KJ, Yu Z, Wood KL, Shmalo JA, Sheski FD, Farber MO, Wilkes DS, Nelson RP. Comparison of Pulmonary Complications after Nonmyeloablative and Conventional Allogeneic Hematopoietic Cell Transplant. Biol Blood Marrow Transplant 2012; 18:1827-34. [DOI: 10.1016/j.bbmt.2012.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 06/17/2012] [Indexed: 01/21/2023]
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28
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Airway distensibility with lung inflation after allogeneic haematopoietic stem-cell transplantation. Respir Physiol Neurobiol 2012; 184:80-5. [DOI: 10.1016/j.resp.2012.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 07/23/2012] [Accepted: 07/24/2012] [Indexed: 11/30/2022]
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