Casal Ana, Riveiro Vanessa, Suárez-Antelo Juan, Ferreiro Lucía, Rodríguez-Núñez Nuria, Toubes María E, Valdés Luis
Department of Pneumology, Santiago de Compostela University Hospital Complex, Santiago de Compostela, Spain.
Santiago de Compostela Health Research Institute (IDIS), Santiago de Compostela, Spain.
J Thorac Dis. 2024 Dec 31;16(12):8771-8781. doi: 10.21037/jtd-24-1063. Epub 2024 Dec 20.
Haematopoietic stem cell transplantation (HCT) is an established treatment for a wide variety of haematological diseases, both malignant and non-malignant. Infectious and non-infectious post-HCT pulmonary complications are a major cause of morbidity and mortality, with non-infectious complications becoming more prominent in recent decades as prophylaxis has led to a decrease in infectious complications. Globally, these complications can be divided into three phases (neutropenic, early and late phase) depending on their time of onset in relation to the graft. There is a growing awareness that the assessment of the patient undergoing HCT should start before the transplantation itself. It is known that total body irradiation dose, the source of HCT, myeloablative regimens or lower baseline lung function are key risk factors in the development of pulmonary complications. In general, the treatment of these entities consists of administration of corticosteroids with variable response, which highlights the need to better understand the underlying biology in order to have new drugs with more directed targets to improve the prognosis of post-HCT non-infectious pulmonary complications. In view of the limited therapeutic response mentioned above, preventive measures for patients undergoing HCT, such as conditioning of less ablative regimens or pre-selection of high-risk cases, are of paramount importance in order to mitigate the severity of these devastating pulmonary complications.
造血干细胞移植（HCT）是治疗多种恶性和非恶性血液系统疾病的既定疗法。HCT后的感染性和非感染性肺部并发症是发病和死亡的主要原因，随着预防措施使感染性并发症减少，非感染性并发症在近几十年来变得更加突出。在全球范围内，这些并发症可根据其相对于移植物的发病时间分为三个阶段（中性粒细胞减少期、早期和晚期）。人们越来越意识到，对接受HCT的患者的评估应在移植本身之前就开始。已知全身照射剂量、HCT的来源、清髓方案或较低的基线肺功能是发生肺部并发症的关键风险因素。一般来说，这些病症的治疗包括使用皮质类固醇，但其反应不一，这突出表明需要更好地了解潜在生物学机制，以便开发具有更有针对性靶点的新药，从而改善HCT后非感染性肺部并发症的预后。鉴于上述有限的治疗反应，对接受HCT的患者采取预防措施，如采用强度较小的预处理方案或对高危病例进行预先筛选，对于减轻这些严重肺部并发症的严重程度至关重要。
