AP-HP, Hôpital Saint-Louis, Service de Pneumologie, Paris, France.
Université Paris Diderot, Sorbonne Paris Cité, UMR 1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, Paris, France.
Eur Respir J. 2018 May 3;51(5). doi: 10.1183/13993003.02617-2017. Print 2018 May.
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.
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）的流行病学数据仅来源于回顾性研究，且相互矛盾。我们旨在前瞻性评估 LONIPCs 的发生率、危险因素和结局。
在法国一所大学教学医院，对 2006 年至 2008 年期间接受异基因 HSCT 的连续患者进行筛查，以确定是否符合入组条件。筛选出的 243 例患者中，有 198 例纳入分析。中位（四分位间距）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）和间质性肺疾病（n=12）是最常见的 LONIPCs。纳入后 36 个月，LONIPCs 的估计累积发生率为 19.8%（95%CI 14.2-25.3%）。诊断出 LONIPCs 后估计的中位生存时间为 78.5 个月（95%CI 20.0-未达到）。基于多变量 Cox 模型，HSCT 前任何时间的胸部照射史、HSCT 后 100 天内肺炎史以及第 100 天的用力呼气流量 25-75%预计值低与 LONIPCs 的发生相关。
我们的数据为识别发生 LONIPC 风险较高的患者提供了线索。这些患者应进行密切监测，以便更早地进行 LONIPC 治疗或预防性治疗。
