Patterns of onset and outcome of cryptogenic organizing pneumonia after allogeneic hematopoietic stem cell transplantation
Patterns of onset and outcome of cryptogenic organizing pneumonia after allogeneic hematopoietic stem cell transplantation
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DOI：
10.1007/s12185-019-02643-9
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发表时间：
2019-06-01
影响因子：
2.1
通讯作者：
Kohno, Akio
中科院分区：
文献类型：
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作者：
Adachi, Yoshitaka;Ozeki, Kazutaka;Kohno, Akio
异基因造血干细胞移植（HSCT）后隐源性机化性肺炎（COP）的特点是经常复发。很少有研究检查HSCT后COP的发作和复发模式。我们在一项单中心回顾性研究中调查了HSCT后COP的临床特征，该研究包括165例接受同种异体HSCT的连续患者。18例患者（11%）在HSCT后发生COP。COP发作时的低氧血症和胸腔积液与脐带血移植显著相关（分别为P=0.002和P=0.002）。在6例患者中观察到COP复发，并且与慢性移植物抗宿主病（cGVHD; P=0.013）和脐带血以外的干细胞来源（P=0.038）的存在显著相关。4例COP复发后死于肺功能衰竭。没有接受脐带血移植的患者发生COP复发。这些发现表明，COP发病时的临床特征可能取决于干细胞来源。此外，干细胞来源和cGVHD的存在或缺乏都可能影响COP的复发，这表明需要根据干细胞来源和cGVHD的风险来制定针对COP的治疗策略。
Cryptogenic organizing pneumonia (COP) after allogeneic hematopoietic stem cell transplantation (HSCT) is characterized by frequent recurrence. Few studies have examined onset and recurrence patterns of COP after HSCT. We investigated the clinical features of COP after HSCT in a single-center retrospective study including 165 consecutive patients who underwent allogeneic HSCT. Eighteen patients (11%) developed COP after HSCT. Hypoxemia and pleural effusion at the onset of COP were significantly associated with umbilical cord blood transplantation (P=0.002 and P=0.002, respectively). Recurrence of COP was observed in six patients and significantly associated with the presence of chronic graft-versus-host disease (cGVHD; P=0.013) and stem cell sources other than umbilical cord blood (P=0.038). Four patients with COP died of pulmonary failure after recurrence of COP. No patients who underwent umbilical cord blood transplantation experienced recurrence of COP. These findings suggest that the clinical features at the onset of COP may depend on stem cell sources. Moreover, both stem cell source and the absence or presence of cGVHD may affect COP recurrence, indicating the need to develop treatment strategies against COP according to stem cell source and risk of cGVHD.