Lee Yoon-Kyoung, Huh Rimm, Kim Jihyun, Ahn Kangmo, Sung Ki Woong, Cho Joongbum
Department of Paediatrics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Critical Care Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
Respirology. 2016 Aug;21(6):1068-74. doi: 10.1111/resp.12787. Epub 2016 Apr 12.
High-dose chemotherapy (HDCT) followed by autologous haematopoietic stem cell transplantation (HSCT) is widely used in paediatric cancer patients, but few data about noninfectious interstitial lung disease (ILD) following this treatment are available. Therefore, we aimed to evaluate the incidence, clinical features and risk factors of noninfectious ILD after HDCT in paediatric patients.
This was a retrospective cohort study of paediatric solid tumour patients who underwent HDCT and autologous HSCT between 1997 and 2012. ILD was diagnosed using clinical symptoms and radiography after excluding cardiac, renal and infectious causes. Risk factors were analysed using a Cox proportional hazard regression model.
Three hundred and forty patients were enrolled, and the median age was 3 years (interquartile range 1-7). Eight patients (2.4%) were diagnosed with noninfectious ILD. The median duration of symptom onset was 30 months (range 7-74). Six (75%) of eight ILD patients died during the study period, even though steroids were administered for treatment. High-dose cyclophosphamide use (hazard ratio = 11.37, 95% confidence interval = 1.38-93.32, P = 0.023) and sex (hazard ratio = 0.10, 95% confidence interval = 0.01-0.84, P = 0.034) were associated with late-onset, noninfectious ILD upon multivariate analysis.
The incidence of noninfectious ILD after HDCT and autologous HSCT was not negligible, and the clinical features of ILD showed late onset and a poor prognosis. Female gender and high-dose cyclophosphamide treatment may be risk factors for noninfectious ILD, but further studies with a larger number of ILD patients are suggested.
大剂量化疗（HDCT）联合自体造血干细胞移植（HSCT）广泛应用于儿童癌症患者，但关于该治疗后非感染性间质性肺病（ILD）的数据较少。因此，我们旨在评估儿童患者HDCT后非感染性ILD的发病率、临床特征及危险因素。
这是一项对1997年至2012年间接受HDCT和自体HSCT的儿童实体瘤患者的回顾性队列研究。排除心脏、肾脏和感染性病因后，根据临床症状和影像学检查诊断ILD。使用Cox比例风险回归模型分析危险因素。
共纳入340例患者，中位年龄为3岁（四分位间距1 - 7岁）。8例患者（2.4%）被诊断为非感染性ILD。症状出现的中位持续时间为30个月（范围7 - 74个月）。8例ILD患者中有6例（75%）在研究期间死亡，尽管接受了类固醇治疗。多因素分析显示，使用大剂量环磷酰胺（风险比=11.37，95%置信区间=1.38 - 93.32，P = 0.023）和性别（风险比=0.10，95%置信区间=0.01 - 0.84，P = 0.034）与迟发性非感染性ILD相关。
HDCT和自体HSCT后非感染性ILD的发病率不可忽视，ILD的临床特征表现为发病较晚且预后较差。女性性别和大剂量环磷酰胺治疗可能是非感染性ILD的危险因素，但建议对更多ILD患者进行进一步研究。
