>From the Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2024 May;22(5):373-380. doi: 10.6002/ect.2023.0330.
We aimed to reveal the incidence of lateonset noninfectious pulmonary complications and bronchiolitis obliterans syndrome and risk factors involved in development.
In this cross-sectional study, we retrospectively investigated 745 patients who underwent allogeneic hematopoietic stem cell transplantation in our hospital between January 2000 and December 2020. We evaluated demographic characteristics, comorbidities, and hematopoietic stem cell transplantation characteristics to determine possible risk factors affecting development of lateonset noninfectious pulmonary complications and bronchiolitis obliterans syndrome.
Of 745 patients, 8.9% (n = 66) had late-onset noninfectious pulmonary complications. Complications included 38 patients with bronchiolitis obliterans syndrome, 13 with venous thromboembolism, 8 with cryptogenic organizing pneumonia, 5 with pneumothorax, 4 with interstitial lung disease-restrictive graft-versus-host disease, 5 with bronchiectasis, 2 with pneumomediastinum, and 1 with pleural effusion. Patients with and without complications were not significantly differentin terms of smoking history, hematopoietic stem cell transplantation characteristics, and conditioning regimens. Patients with complications had higher busulfan and lower antithymocyte globulin use than those without complications (both P<.05). Patients with complications more commonly had hematopoietic stem cell transplantation from related donors and chronic graft-versus-host disease (P < .05). Patients with bronchiolitis obliterans syndrome had more frequent use of busulfan (P <.05) but less frequent use of total body irradiation (P <.05) and antithymocyte globulin (P <.05) than those without this syndrome. Rate of hematopoietic stem cell transplantation from a related donor (P < .05) and frequency of chronic graftversus-host disease (P < .001) were significantly higher in patients with bronchiolitis obliterans syndrome, presented with bronchiectasis (78.6%), air trapping (67.9%), bronchial wallthickening (53.6%), and mosaic attenuation (39.3%) in thorax computed tomography. Pretransplant spirometry did not predict bronchiolitis obliterans syndrome development.
Determining risk factors for late-onset noninfectious pulmonary complications is needed to aid in prevention and follow-up.
本研究旨在揭示迟发性非感染性肺部并发症和闭塞性细支气管炎综合征的发生率以及相关的发病危险因素。
本回顾性研究纳入了 2000 年 1 月至 2020 年 12 月在我院接受异基因造血干细胞移植的 745 例患者。我们评估了患者的人口统计学特征、合并症和造血干细胞移植特征，以确定可能影响迟发性非感染性肺部并发症和闭塞性细支气管炎综合征发生的危险因素。
745 例患者中，8.9%（66 例）发生迟发性非感染性肺部并发症。其中，38 例为闭塞性细支气管炎综合征，13 例为静脉血栓栓塞症，8 例为特发性机化性肺炎，5 例为气胸，4 例为间质性肺病-限制性移植物抗宿主病，5 例为支气管扩张症，2 例为纵隔气肿，1 例为胸腔积液。有并发症和无并发症的患者在吸烟史、造血干细胞移植特征和预处理方案方面无显著差异。有并发症的患者使用白消安的比例高于无并发症的患者，而使用抗胸腺细胞球蛋白的比例低于无并发症的患者（均 P<.05）。有并发症的患者更常接受亲缘供者造血干细胞移植和慢性移植物抗宿主病（P <.05）。与无闭塞性细支气管炎综合征的患者相比，有该综合征的患者更常使用白消安（P <.05），而更少使用全身照射（P <.05）和抗胸腺细胞球蛋白（P <.05）。有亲缘供者造血干细胞移植（P <.05）和慢性移植物抗宿主病（P <.001）的患者比例在有闭塞性细支气管炎综合征的患者中显著升高，其胸部 CT 表现为支气管扩张症（78.6%）、空气潴留（67.9%）、支气管壁增厚（53.6%）和马赛克衰减（39.3%）。移植前肺功能检查不能预测闭塞性细支气管炎综合征的发生。
确定迟发性非感染性肺部并发症的危险因素有助于预防和随访。
