Incidence of Pulmonary GVHD Is Increased and Incidence of Late Infection and Pulmonary Embolism Is Comparable Comparing Adult MRD Versus Cord Transplant Patients

Abstract

Pulmonary GVHD (bronchiolitis obliterans organizing pneumonia (BOOP) and bronchiolitis obliterans (BO)), infection, and pulmonary embolism (PE) are the most common late pulmonary complications of allogeneic stem cell transplantation. We compared outcomes of these pulmonary complications among adult patients undergoing first double unit cord blood transplant (CBT) or matched related donor transplant (MRD) at our center between July 2013 and July 2018. Patients experiencing death or relapse before 100 days post-transplant were excluded; 153 CBT and 77 MRD patients were included. Only events occurring after day 100 were included. Patient details are summarized in Table 1. Incidence of complications were described using the Kaplan-Meier method and comparisons were made using a log-rank test. Incidence of BOOP and BO were higher in the MRD group versus the CBT group (for BOOP p=0.004, 2 yr incidence 15% for MRD and 3% for CBT; for BO P=0.015 2 yr incidence 9% for MRD and 1% for CBT.) Incidence of first infection and PE were comparable for each group (for first infection p=0.65, 2 yr incidence 16% for MRD and 20% for CBT; for PE 0=0.74 2 yr incidence 3% for MRD and 7% for CBT.) 10 CBT (7%) and 6 MRD patients (8%) had more than one infection. During the period reviewed, 9 CBT (6%) and 6 MRD (8%) patients died of issues related directly to these pulmonary complications. MRD patients have a higher rate of BO and BOOP than CBT patients and a comparable rate of late infections and PE. Comprehensive review all pulmonary outcomes for MRD and CBT patients undergoing transplant at our center, including early complications, is ongoing.