Timeline of pulmonary complications after hematopoietic stem cell transplantation in children

Abstract

Background: Hematopoietic stem cell transplantation (HSCT) has been a life-saving treatment for malignant and nonmalignant pediatric diseases. Its success is often restricted by pulmonary complications (PCs). Methods: A retrospective chart review of 174 pediatric patients of aged between 4 to 18 years, receiving HSCT between 2009 and 2012 was performed. Results: Eighty three PCs developed in 66 patients (37.9%): 57 infectious (24.7%), 26 noninfectious (14.9%), and 3 both infectious and noninfectious (1.7%). The cumulative incidence of infectious PCs was increased earlier than noninfectious PCs after HSCT ( P =0.027). The main infectious PCs were unspecified pneumonia (18 [10.3%]), fungal pneumonia (14 [8%]), acute bronchitis (7 [4%]) and viral pneumonia (7 [4%]). Bronchiolitis obliterans, air trapping, cryptogenic organizing pneumonia were the common noninfectious complications. Independent factors associated with PCs included cell source of HSCT and severity of chronic graft versus host dieases (GvHD, P 0.001). Moderate and severe chronic GVHD showed an association with noninfectious PCs at subdistribution hazard ratios of 6.05 and 11.90, respectively, compared with none chronic GVHD. The mortality risk following noninfectious PCs was much increased during the first year and relatively stable thereafter. Whereas, the mortality risk following infectious PCs showed continuous increase until second year. Conclusion: The development of infectious complications was more related to decreased survival. Knowing the patient9s timeline after HSCT may be helpful for early recognition and treatment of PCs.