Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Pediatric Transplants

Risk factor analysis of idiopathic pneumonia syndrome after allogeneic hematopoietic SCT in children

Bone Marrow Transplantation volume 49, pages 38–41 (2014)Cite this article

Subjects

Abstract

Idiopathic pneumonia syndrome (IPS) is a critical complication following allogeneic hematopoietic SCT (HSCT); however, few reports have analyzed the risk factors for IPS in children. A total of 210 consecutive pediatric patients, including 131 boys and 79 girls, with various hematologic malignancies, aplastic anemia or solid tumors who underwent allogeneic HSCT were analyzed to clarify the incidence and risk factors for IPS. Patient and transplantation characteristics after allogeneic HSCT were compared between patients with and without IPS. Cumulative incidence rates of IPS 120 days after allogeneic HSCT were 6.7% (14/210). Of 14 patients with IPS, 11 (78.6%) died after developing IPS. The presence of prior HSCT was more frequent in patients with IPS (IPS group) than in those without IPS (non-IPS group; 35.7 vs 12.8%, respectively, P=0.018). The IPS group contained more patients with acute GVHD (grade II–IV) than the non-IPS group (50.0 vs 18.9%, respectively, P=0.006). The association of these two factors with IPS was further confirmed by multivariate analysis. We should be aware of these risk factors in patients who have undergone allogeneic HSCT.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Clark JG, Hansen JA, Hertz MI, Parkman R, Jensen L, Peavy HH . Idiopathic pneumonia syndrome after bone marrow transplantation. Am Rev Respir Dis 1993; 147: 1601–1606.

    Article  CAS  PubMed  Google Scholar 

  2. Atkinson K, Nivison-Smith I, Dodds A, Concannon A, Milliken S, Downs K . A comparison of the pattern of interstitial pneumonitis following allogeneic bone marrow transplantation before and after the introduction of prophylactic ganciclovir therapy in 1989. Bone Marrow Transplant 1998; 21: 691–695.

    Article  CAS  PubMed  Google Scholar 

  3. Crawford SW, Longton G, Storb R . Acute graft-versus-host disease and the risks for idiopathic pneumonia after marrow transplantation for severe aplastic anemia. Bone Marrow Transplant 1993; 12: 225–231.

    CAS  PubMed  Google Scholar 

  4. Meyers JD, Flournoy N, Thomas ED . Nonbacterial pneumonia after allogeneic marrow transplantation: a review of ten years' experience. Rev Infect Dis 1982; 4: 1119–1132.

    Article  CAS  PubMed  Google Scholar 

  5. Wingard JR, Mellits ED, Sostrin MB, Chen DY, Burns WH, Santos GW et al. Interstitial pneumonitis after allogeneic bone marrow transplantation. Nine-year experience at a single institution. Medicine 1988; 67: 175–186.

    Article  CAS  PubMed  Google Scholar 

  6. Weiner RS, Bortin MM, Gale RP, Gluckman E, Kay HE, Kolb HJ et al. Interstitial pneumonitis after bone marrow transplantation. Assessment of risk factors. Ann Intern Med 1986; 104: 168–175.

    Article  CAS  PubMed  Google Scholar 

  7. Weiner RS, Horowitz MM, Gale RP, Dicke KA, van Bekkum DW, Masaoka T et al. Risk factors for interstitial pneumonia following bone marrow transplantation for severe aplastic anaemia. Br J Haematol 1989; 71: 535–543.

    Article  CAS  PubMed  Google Scholar 

  8. Grañena A, Carreras E, Rozman C, Salgado C, Sierra J, Algara M et al. Interstitial pneumonitis after BMT: 15 years experience in a single institution. Bone Marrow Transplant 1993; 11: 453–458.

    PubMed  Google Scholar 

  9. Afessa B, Litzow MR, Tefferi A . Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation. Bone Marrow Transplant 2001; 28: 425–434.

    Article  CAS  PubMed  Google Scholar 

  10. Fukuda T, Hackman RC, Guthrie KA, Sandmaier BM, Boeckh M, Maris MB et al. Risks and outcomes of idiopathic pneumonia syndrome after nonmyeloablative and conventional conditioning regimens for allogeneic hematopoietic stem cell transplantation. Blood 2003; 102: 2777–2785.

    Article  PubMed  Google Scholar 

  11. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer / Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008; 46: 1813–1821.

    Article  PubMed  Google Scholar 

  12. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  13. Kanda Y . Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013; 48: 452–458.

    Article  CAS  PubMed  Google Scholar 

  14. Keates-Baleeiro J, Moore P, Koyama T, Manes B, Calder C, Frangoul H . Incidence and outcome of idiopathic pneumonia syndrome in pediatric stem cell transplant recipients. Bone Marrow Transplant 2006; 38: 285–289.

    Article  CAS  PubMed  Google Scholar 

  15. Nishio N, Yagasaki H, Takahashi Y, Muramatsu H, Hama A, Tanaka M et al. Late-onset non-infectious pulmonary complications following allogeneic hematopoietic stem cell transplantation in children. Bone Marrow Transplant 2009; 44: 303–308.

    Article  CAS  PubMed  Google Scholar 

  16. Versluys AB, Rossen JW, van Ewijk B, Schuurman R, Bierings MB, Boelens JJ . Strong association between respiratory viral infection early after hematopoietic stem cell transplantation and the development of life-threatening acute and chronic alloimmune lung syndromes. Biol Blood Marrow Transplant 2010; 16: 782–791.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sakaguchi H, Takahashi Y, Watanabe N, Doisaki S, Muramatsu H, Hama A et al. Incidence, clinical features, and risk factors of idiopathic pneumonia syndrome following hematopoietic stem cell transplantation in children. Pediatr Blood Cancer 2012; 58: 780–784.

    Article  PubMed  Google Scholar 

  18. Kantrow SP, Hackman RC, Boeckh M, Myerson D, Crawford SW . Idiopathic pneumonia syndrome: changing spectrum of lung injury after marrow transplantation. Transplantation 1997; 63: 1079–1086.

    Article  CAS  PubMed  Google Scholar 

  19. Yanik G, Hellerstedt B, Custer J, Hutchinson R, Kwon D, Ferrara JL et al. Etanercept (Enbrel) administration for idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2002; 8: 395–400.

    Article  CAS  PubMed  Google Scholar 

  20. Panoskaltsis-Mortari A, Griese M, Madtes DK, Belperio JA, Haddad IY, Folz RJ et al. An official American Thoracic Society research statement: noninfectious lung injury after hematopoietic stem cell transplantation: idiopathic pneumonia syndrome. Am J Respir Crit Care Med 2011; 183: 1262–1279.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Della Volpe A, Ferreri AJ, Annaloro C, Mangili P, Rosso A, Calandrino R et al. Lethal pulmonary complications significantly correlate with individually assessed mean lung dose in patients with hematologic malignancies treated with total body irradiation. Int J Radiat Oncol Biol Phys 2002; 52: 483–488.

    Article  PubMed  Google Scholar 

  22. Shankar G, Scott Bryson J, Darrell Jennings C, Kaplan AM, Cohen DA . Idiopathic pneumonia syndrome after allogeneic bone marrow transplantation in mice. Role of pretransplant radiation conditioning. Am J Respir Cell Mol Biol 1999; 20: 1116–1124.

    Article  CAS  PubMed  Google Scholar 

  23. Yanik GA, Ho VT, Levine JE, White ES, Braun T, Antin JH et al. The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation. Blood 2008; 112: 3073–3081.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Tizon R, Frey N, Heitjan DF, Tan KS, Goldstein SC, Hexner EO et al. High-dose corticosteroids with or without etanercept for the treatment of idiopathic pneumonia syndrome after allo-SCT. Bone Marrow Transplant 2012; 47: 1332–1337.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan

    H Sano, R Kobayashi, D Suzuki, K Kishimoto, K Yasuda & K Kobayashi

  2. Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    A Iguchi

Authors
  1. H Sano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Iguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K Kishimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H Sano.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sano, H., Kobayashi, R., Iguchi, A. et al. Risk factor analysis of idiopathic pneumonia syndrome after allogeneic hematopoietic SCT in children. Bone Marrow Transplant 49, 38–41 (2014). https://doi.org/10.1038/bmt.2013.123

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2013.123

Keywords

This article is cited by

Search

Advanced search

Quick links