Clinical study of idiopathic pneumonia syndrome early after allogeneic hematopoietic stem cell transplantation

Abstract

Objective To investigate the independent risk factors and the pathogenesis of idiopathic pneumonia syndrome (IPS) early following allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods We retrospectively reviewed the clinical data of 192 patients undergoing allo-HSCT and analyzed the incidence and clinical manifestations of 23 cases of IPS.The 11 clinical parameters were selected for Logistic univariate analysis: age, gender, underlying disease, disease status at transplant, transplant type, conditioning regimens, donor type, aGVHD, severity of aGVHD, HLA disparity, organ involvement of aGVHD.Factors that were statistically significant on univariate analysis were evaluated by multivariate analysis using a Logistic regression.We explored the possible pathogenesis of IPS with review of the literature.Results Twenty-three of 192 patients developed IPS (12.0 %).Median time to IPS onset after allo-HSCT was 76 days (range 32～ 120 days), 20 patients with IPS died because of the rapid progression of respiratory failure (87.0 %), median time to death after the diagnosis of IPS was 9 days (range 3～92 days), and the remaining 3 patients were successfully treated by steroid; 19 patients with IPS developed aGVHD (82.6 %), with aGVHD of gut in 16 patients (69.6 %).The following 6 factors were associated with an increased risk of IPS by univariate analysis: not in remission, unrelated donor, HLA disparity, occurrence of aGVHD, grade Ⅲ～Ⅳ aGVHD, and aGVHD of gut.These risk factors were entered into a multivariate analysis model.Only unrelated donor, grade Ⅲ～ⅣaGVHD, and aGVHD of gut were identified as being significantly associated with the occurrence of IPS.Conclusion Patients were at increased risk of IPS if they had received graft from unrelated donor or developed grade Ⅲ～Ⅳ aGVHD, especially aGVHD of gut, suggesting that IPS possibly represents aGVHD involving the lung interstitium. Key words: Hematopoietic stem cell transplantation; Lung diseases, interstitial; Graft versus host disease