Alhomoud Mohammad, Chokr Nora, Gomez-Arteaga Alexandra, Chen Zhengming, Escalon Joanna G, Legasto Alan C, Brusca-Augello Geraldine, Yamshon Samuel, Plate Markus, Zappetti Dana, Hsu Jing-Mei, Phillips Adrienne, Mayer Sebastian, Shore Tsiporah, Van Besien Koen
Division of Hematology and Oncology, Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
Division of Hematology and Oncology, Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
Transplant Cell Ther. 2023 May;29(5):326.e1-326.e10. doi: 10.1016/j.jtct.2023.01.029. Epub 2023 Feb 3.
Pulmonary complications constitute a major cause of morbidity and mortality in the post-allogenic hematopoietic stem cell transplantation (alloHSCT) period. Although chest X-ray (CXR) is customarily used for screening, we have used chest computed tomography (CT) scans. To characterize the prevalence of abnormalities and explore their impact on alloHSCT eligibility and outcomes post-transplantation, we conducted a retrospective analysis using real-world data collected at our center for adult patients who were evaluated for alloHSCT between January 2013 and December 2020 and identified 511 eligible patients. The most common primary disease was acute myeloid leukemia, in 49% of patients, followed by myelodysplastic syndrome (23%), lymphoma (11%), and acute lymphocytic leukemia (10%). Abnormal screening chest CT results were found in 199 patients (39%). The most frequent detected abnormality was pulmonary nodule, in 78 patients (35%), followed by consolidation in 42 (19%), ground-glass opacification in 33 (15%), bronchitis and bronchiolitis in 25 (11%), pleural effusions in 14 (6%), and new primary cancer in 7 (2%). CXR detected abnormalities in only approximately one-half of the patients (48%) with an abnormal chest CT scan. Among the 199 patients with an abnormal chest CT scan, 98 (49%) underwent further assessment and/or intervention before transplantation. The most common workup was pulmonary consultation in 32%, followed by infectious diseases consultation in 24%. Lung biopsy was obtained in 20%, and antimicrobial therapy was initiated after confirming an infection diagnosis in 20%. Patients with an abnormal chest CT scan demonstrated worse overall survival (P = .032), nonrelapse mortality (P = .015), and pulmonary-related mortality (P < .001) compared to those with a normal chest CT scan. Our study suggests that pretransplantation screening chest CT is beneficial in uncovering invasive infections and underlying malignancies and allows for appropriate interventions before alloHSCT to prevent potentially serious post-transplantation complications without causing a delay in alloHSCT. Nevertheless, abnormal CT findings prior to transplantation may be associated with overall worse prognosis.
肺部并发症是异基因造血干细胞移植（alloHSCT）后发病和死亡的主要原因。虽然胸部X线（CXR）通常用于筛查，但我们使用的是胸部计算机断层扫描（CT）。为了描述异常情况的发生率，并探讨其对alloHSCT资格和移植后结局的影响，我们使用在我们中心收集的真实世界数据，对2013年1月至2020年12月期间接受alloHSCT评估的成年患者进行了回顾性分析，确定了511例符合条件的患者。最常见的原发性疾病是急性髓系白血病，占49%的患者，其次是骨髓增生异常综合征（23%）、淋巴瘤（11%）和急性淋巴细胞白血病（10%）。199例患者（39%）胸部CT筛查结果异常。最常检测到的异常是肺结节，78例（35%），其次是实变42例（19%）、磨玻璃影33例（15%）、支气管炎和细支气管炎25例（11%）、胸腔积液14例（6%）以及新发原发性癌症7例（2%）。胸部X线仅在约一半（48%）胸部CT扫描异常的患者中检测到异常。在199例胸部CT扫描异常的患者中，98例（49%）在移植前接受了进一步评估和/或干预。最常见的检查是32%的患者进行了肺部会诊，其次是24%的患者进行了感染病会诊。20%的患者进行了肺活检，20%的患者在确诊感染后开始了抗菌治疗。与胸部CT扫描正常的患者相比，胸部CT扫描异常的患者总生存期更差（P = 0.032）、非复发死亡率更高（P = 0.015）以及肺部相关死亡率更高（P < 0.001）。我们的研究表明，移植前胸部CT筛查有助于发现侵袭性感染和潜在恶性肿瘤，并允许在alloHSCT前进行适当干预，以预防潜在的严重移植后并发症，而不会导致alloHSCT延迟。然而，移植前CT检查结果异常可能与总体预后较差有关。
