Grañena A, Carreras E, Rozman C, Salgado C, Sierra J, Algara M, Rovira M, Valls A
Postgraduate School of Hematology Farreras Valentí, Hospital Clinic, University of Barcelona, Spain.
Bone Marrow Transplant. 1993 Jun;11(6):453-8.
Data from 311 patients with hematological malignancies who received an autologous, allogeneic or syngeneic BMT in a single institution were analyzed. Interstitial pneumonia (IPn) was observed in 58 patients. Two years actuarial probability of IPn was 26.8%. In 50% of cases CMV was detected. In 23 patients (39.7%) IPn was considered idiopathic. The median time from BMT to IPn was 63.5 (range 7-720) days. Patients submitted to allogeneic BMT had a significantly higher risk of developing IPn than patients receiving syngeneic or autologous BMT (34.1% vs 16.7% and 4.9%, respectively; p = 0.0006). Among 230 patients receiving allogeneic transplant, factors with a higher risk for IPn in univariate analysis were: age over 20 years, CML, alloimmunized donor, previous splenectomy, acute and chronic GVHD. When the analysis was restricted to patients with a CMV-associated IPn, all factors except alloimmunization maintained their significance. Multivariate analysis showed that only acute GVHD (p < 0.0001) and a diagnosis of CML (p < 0.001) in the whole group of allogeneic transplants, and acute GVHD (p < 0.001) and splenectomy (p < 0.003) in CMV-associated IPn, maintained their significance. These results are discussed within the frame work of the clinical application of BMT.
分析了在单一机构接受自体、异体或同基因骨髓移植（BMT）的311例血液系统恶性肿瘤患者的数据。58例患者观察到间质性肺炎（IPn）。IPn的两年精算概率为26.8%。50%的病例检测到巨细胞病毒（CMV）。23例患者（39.7%）的IPn被认为是特发性的。从BMT到IPn的中位时间为63.5（范围7 - 720）天。接受异体BMT的患者发生IPn的风险显著高于接受同基因或自体BMT的患者（分别为34.1% vs 16.7%和4.9%；p = 0.0006）。在230例接受异体移植的患者中，单因素分析显示IPn风险较高的因素为：年龄超过20岁、慢性粒细胞白血病（CML）、供体同种免疫、既往脾切除术、急性和慢性移植物抗宿主病（GVHD）。当分析仅限于CMV相关的IPn患者时，除同种免疫外的所有因素仍具有显著性。多因素分析显示，在整个异体移植组中，只有急性GVHD（p < 0.0001）和CML诊断（p < 0.001），以及在CMV相关的IPn中急性GVHD（p < 0.001）和脾切除术（p < 0.003）仍具有显著性。在BMT临床应用的框架内对这些结果进行了讨论。
