Patriarca F, Skert C, Sperotto A, Damiani D, Cerno M, Geromin A, Zaja F, Stocchi R, Prosdocimo S, Fili' C, Fanin R
Division of Haematology, Bone Marrow Transplantation Unit, Department of Clinical and Morphological Research, University Hospital, Udine, Italy.
Bone Marrow Transplant. 2004 Apr;33(7):751-8. doi: 10.1038/sj.bmt.1704426.
We evaluated the incidence, the risk factors, and the outcome of late-onset noninfectious pulmonary complications (LONIPCs) among 50 patients who underwent allogeneic stem cell transplantation from unrelated donors. Of the 39 patients surviving at least 3 months, 10 (26%) fulfilled the diagnostic criteria of LONIPCs and were further subclassified as having bronchiolitis obliterans (four patients), bronchiolitis obliterans with organizing pneumonia (four patients), and interstitial pneumonia (two patients). Two patients had a durable partial remission after treatment with prednisone and cyclosporine; the remaining eight patients did not respond to treatment and five of them died of respiratory failure. Advanced stage of disease at transplant and chronic extensive graft-versus-host disease (GVHD) were significantly associated with the development of LONIPCs. Pulmonary function test (PFT) results before transplantation were similar in all patients, but patients with LONIPCs had a significant decrease in PFT indexes at the third month after BMT compared with controls. Moreover, the rate of cyclosporine taper during the fourth and fifth months after BMT was significantly more rapid in patients with LONIPCs than in controls, suggesting that the risk of LONIPCs may be influenced by a faster reduction of GVHD prophylaxis.
我们评估了50例接受非血缘供者异基因干细胞移植患者的迟发性非感染性肺部并发症（LONIPC）的发生率、危险因素及预后。在至少存活3个月的39例患者中，10例（26%）符合LONIPC的诊断标准，并进一步分为闭塞性细支气管炎（4例）、闭塞性细支气管炎伴机化性肺炎（4例）和间质性肺炎（2例）。2例患者经泼尼松和环孢素治疗后获得持久部分缓解；其余8例患者治疗无效，其中5例死于呼吸衰竭。移植时疾病分期较晚和慢性广泛性移植物抗宿主病（GVHD）与LONIPC的发生显著相关。所有患者移植前的肺功能测试（PFT）结果相似，但与对照组相比，LONIPC患者在骨髓移植后第3个月时PFT指标显著下降。此外，LONIPC患者在骨髓移植后第4和第5个月环孢素减量的速度明显快于对照组，提示LONIPC的风险可能受GVHD预防措施更快减量的影响。
