Noninfectious lung complications after allogeneic haematopoietic stem cell transplantation
Noninfectious lung complications after allogeneic haematopoietic stem cell transplantation
复制标题
DOI：
10.1183/13993003.02617-2017
复制
发表时间：
2018-05-01
影响因子：
24.3
通讯作者：
Tazi, Abdellatif
中科院分区：
文献类型：
--
作者：
Bergeron, Anne;Chevret, Sylvie;Tazi, Abdellatif
异基因造血干细胞移植（HSCT）后迟发性非感染性肺部并发症（LONIPCs）的流行病学数据完全来自回顾性研究，并且相互矛盾。我们的目的是前瞻性地评估LONIPCs的发病率、危险因素和结局，所有在2006年至2008年期间在法国一所大学教学医院接受同种异体HSCT的连续患者都被筛选纳入本研究。合格患者为第100天存活的患者。在243例筛选患者中，198例患者纳入分析。中位（四分位距）随访时间为72.3（15.2-88.5）个月。43例患者中诊断出55例LONIPCs。闭塞性细支气管炎综合征（n=22）和间质性肺病（n=12）是最常见的LONIPC。在入选后36个月，LONIPC的估计累积发生率为19.8%（95% CI 14.2-25.3%）。LONIPC诊断后的估计中位生存期为78.5个月（95% CI 20.0-未达到）。多变量考克斯模型显示，HSCT前任何时间的胸部放疗史、HSCT后100天内的肺炎史以及第100天用力呼气流量较低（25-75%）与LONIPCs的发生相关，本研究为确定LONIPCs高危患者提供了线索。这些患者应作为密切监测的目标，以提供早期LONIPC治疗或预防性治疗。
Epidemiological data on late-onset noninfectious pulmonary complications (LONIPCs) following allogeneic haematopoietic stem cell transplantation (HSCT) are derived exclusively from retrospective studies and are conflicting. We aimed to evaluate prospectively the incidence, risk factors and outcomes for LONIPCs.All consecutive patients scheduled to receive allogeneic HSCT between 2006 and 2008 at a university teaching hospital in France were screened for inclusion in the study. Eligible patients were those surviving at day 100. Among 243 screened patients, 198 patients were included in the analysis. The median (interquartile range) follow-up was 72.3 (15.2-88.5) months. 55 LONIPCs were diagnosed in 43 patients. Bronchiolitis obliterans syndrome (n=22) and interstitial lung disease (n=12) were the most common LONIPCs. At 36 months after inclusion, the estimated cumulative incidence of LONIPCs was 19.8% (95% CI 14.2-25.3%). The estimated median survival after the diagnosis of LONIPCs was 78.5 months (95% CI 20.0-not reached). Based on a multivariate Cox model, a history of chest irradiation anytime prior to HSCT, a history of pneumonia within 100 days post-HSCT and a low mean forced expiratory flow at 25-75% of forced vital capacity at day 100 were associated with the development of LONIPCs.Our data provide clues to identify patients at high risk of developing LONIPCs. These patients should be targeted for close monitoring to provide earlier LONIPC treatment or prophylactic treatment.