Non-infectious bronchiolitis as an early pulmonary complication of hematopoietic stem cell transplantation

Clinical features of late onset non-infectious pulmonary complications following pediatric allogeneic hematopoietic stem cell transplantation

BACKGROUND

Late onset non-infectious pulmonary complications (LONIPCs) are major causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We evaluated the incidence and the outcomes of LONIPCs in children who underwent allo-HSCT.

METHODS

Data for 143 children who underwent allo-HSCT at Asan Medical Center between April 2002 and April 2009 were reviewed, and the 127 who survived more than three months were enrolled.

RESULTS

Eleven (8.7%) developed LONIPCs at a median eight months (range 3-14 months) after allo-HSCT, presenting with cough and dyspnea. Six had bronchiolitis obliterans and five had idiopathic pneumonia syndrome. FVC declined more significantly in LONIPC than in non-LONIPC patients three months after HSCT. A significant risk factor for the development of LONIPCs was chronic graft-versus-host disease (GVHD) (p = 0.002). At a median follow-up of 36 months, the three-yr overall survival rate in LONIPC patients was significantly lower than that of non-LONIPC patients (37.4% vs. 72.7%, p = 0.02). The major cause of death was respiratory failure.

CONCLUSIONS

Along with chronic GVHD, deterioration of pulmonary function at three months after HSCT may help in the early identification of patients at risk of subsequent LONIPCs. Considering the poor prognosis of LONIPC, strategies should be aimed at their prevention.

[Non-infectious pulmonary complications after the hematopoietic stem cell transplantation]

Pulmonary complications are important cause of mortality and morbidity after hematopoietic stem cell transplantation, in 30% to 60% of the patients. Improvements in prophylaxis and treatment of infectious complications have been increasing the rate of non-infectious complications. Early diagnosis and treatment of those complications can significantly change the evolution of hematopoietic stem cell transplantation receptors. The objective of this study is to review the most frequent non-infection complications associated to hematopoietic stem cell transplantation since the first bone marrow transplantation performed in 1957. A systematic literature review was performed, using the PICO strategy to ask the questions. The descriptors hematopoietic stem cell transplantation, non-infectious pulmonary complications, systematic review, in portuguese and their english correspondents, were used to access the following databases: MEDLINE, EBM, Embase, Cocrane Library, LILACS and SciELO. In this review, 263 studies were identified, from which 31 were selected for full analyzis. The non-infection pulmonary complications most frequently found were: bronchiolitis obliterans, bronchiolitis obliterans organizing pneumonia, pulmonary edema, idiopathic pneumonia syndrome, delayed pulmonary toxicity syndrome, diffuse alveolar hemorrhage, engrafment syndrome and pulmonary cytolitic thrombi.