Khayyata Said, Soubani Ayman O, Bonnett Michelle, Nassar Hind, Abidi Muneer H, Al-Abbadi Mousa A
Department of Pathology, Harper University Hospital, Wayne State University, Detroit, MI, USA.
Ann Transplant. 2007;12(2):11-8.
Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for hematological malignancies, but this treatment can be associated with a mortality risk.
MATERIAL/METHODS: A ten-year retrospective review of all autopsies was performed where those who underwent HSCT were studied. The major autopsy findings and the cause of death were characterized and compared between those seen in allogeneic and those in autologous HSCT recipients. The study period preceded the use of prophylactic antifungal agents.
A total of 66 autopsies were identified; 52 (79%) received allogeneic and 14 (21%) autologous transplantation. Death occurred at a median of 85 days post transplantation (range 2-1825 days); 36 (55%) died within the first 100 days post stem cells infusion. The major complications for HSCT patients were pulmonary, including diffuse alveolar damage (DAD), acute pneumonia and invasive pulmonary aspergillosis. The most common cause of death in the allogeneic HSCT group was DAD (13/52; 25%), followed by invasive pulmonary aspergillosis (10/52; 19%), acute pneumonia (10/52; 19%) and massive gastrointestinal bleeding (6/52; 12%); in the autologous group causes were disease relapse/progression of the underlying malignancy (4/14; 29%), acute pneumonia (3/14; 21%) and DAD (2/14; 14%).
We conclude that the spectrum of disease entities, commonly diagnosed at autopsy in HSCT recipients may provide insight to clinicians for anticipating complications and consequently help in the management of these high risk patients. The increased infectious complications observed in the allogeneic transplant cases may be explained by immunosuppression and that the study period preceded the use of prophylactic antifungal agents. However, relapse/progression of the disease is the predominant cause of mortality after autologous transplant.
造血干细胞移植（HSCT）是血液系统恶性肿瘤的一种治愈性治疗选择，但这种治疗可能伴有死亡风险。
材料/方法：对所有尸检进行了为期十年的回顾性研究，研究对象为接受HSCT的患者。对同种异体和自体HSCT受者的主要尸检结果和死亡原因进行了特征描述和比较。研究期间在预防性抗真菌药物使用之前。
共确定了66例尸检；52例（79%）接受了同种异体移植，14例（21%）接受了自体移植。死亡发生在移植后中位85天（范围2 - 1825天）；36例（55%）在干细胞输注后的前100天内死亡。HSCT患者的主要并发症为肺部并发症，包括弥漫性肺泡损伤（DAD）、急性肺炎和侵袭性肺曲霉病。同种异体HSCT组最常见的死亡原因是DAD（13/52；25%）,其次是侵袭性肺曲霉病（10/52；19%）、急性肺炎（10/52；19%）和大量胃肠道出血（6/52；12%）；自体移植组的死亡原因是潜在恶性肿瘤的疾病复发/进展（4/14；29%）、急性肺炎（3/14；21%）和DAD（2/14；14%）。
我们得出结论，HSCT受者尸检时常见诊断的疾病谱可能为临床医生预测并发症提供见解，从而有助于管理这些高危患者。同种异体移植病例中观察到的感染并发症增加可能与免疫抑制有关，且研究期间在预防性抗真菌药物使用之前。然而，疾病复发/进展是自体移植后死亡的主要原因。
