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Pulmonary function and long-term survival in patients with PERDS after autologous hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 58, pages 1289–1291 (2023)Cite this article

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Peri-engraftment respiratory distress syndrome (PERDS) is a pulmonary complication occurring in around 5% of autologous hematopoietic cell transplant (HCT) recipients. It is a subset of engraftment syndrome with pulmonary involvement [1, 2]. Prior studies showed that female sex, faster time-to-engraftment, more frequent platelet transfusions and POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin abnormalities) syndrome are all associated with PERDS development and short-term survival of PERDS patients is lower than those without PERDS [3]. Impaired pulmonary function such as low forced expiratory volume in 1 s (FEV1), low forced vital capacity (FVC) and low diffusing capacity for carbon monoxide (DLCO) is associated with increased risk of pulmonary complications after HCT [4, 5]. No data have evaluated whether impaired pulmonary function affects the risk of PERDS. Also, no long-term follow-up of PERDS survivors has been reported. Therefore, we conducted this study to a) evaluate pre-transplant pulmonary function and PERDS risk, and b) determine longer-term outcomes in patients who developed PERDS.

This was a secondary analysis of a previously defined cohort of adult patients who underwent autologous HCT at Mayo Clinic, Rochester, Minnesota between January 1, 2005 and December 31, 2016 [3]. This study was approved by the Mayo Clinic Institutional Review Board and written informed consent was waived by institutional review. PERDS was defined as new pulmonary infiltrates on imaging, hypoxia with new oxygen requirement, clinical syndrome not due to infection or heart failure, and occurring within 5 days of either side of neutrophil engraftment (the first of three consecutive days when the absolute neutrophil count exceeded 500 cells/μl after transplantation) [3]. Patients had pulmonary function testing (PFT) as part of pretransplant evaluation, and we collected their most recent FEV1, FVC and DLCO prior to HCT as baseline. Lung Function Score (LFS) was calculated from the sum of FEV1 and DLCO percent predicted scores where >80% = 1, 70–80% = 2, 60–70% = 3 and <60% = 4 [6]. In patients with PERDS, we identified those with PFT after their PERDS episodes through medical records and reviewed clinical documentation for pulmonary symptoms in those without repeat PFT. Dates of last follow-up, disease relapse and death were collected for survival analysis. Patients were censored when they were lost to follow up or were alive after 5 years. Summary statistics included mean and standard deviation for continuous variables and frequency for categorical variables, and compared using two-sided Student’s t test, paired Student’s t test or chi-squared test when appropriate. Multivariable logistic model incorporated previously known risk factors for PERDS and PFT measurements [3]. Kaplan–Meier estimate and Cox proportional hazard model were used to analyze mortality. Competing risk analysis was performed to evaluate the impact of disease relapse on overall survival. A p-value < 0.05 was considered statistically significant. Statistical analysis was performed using BlueSky Statistics (Chicago, IL, USA) and R Studio Integrated Development Environment (Boston, MA, USA).

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Fig. 1: Long term outcome in PERDS patients.

Data availability

The original data are available upon reasonable request. Please contact the corresponding author.

References

  1. Maiolino A, Biasoli I, Lima J, Portugal AC, Pulcheri W, Nucci M. Engraftment syndrome following autologous hematopoietic stem cell transplantation: definition of diagnostic criteria. Bone Marrow Transplant. 2003;31:393–7. https://doi.org/10.1038/sj.bmt.1703855.

    Article  CAS  PubMed  Google Scholar 

  2. Capizzi SA, Kumar S, Huneke NE, Gertz MA, Inwards DJ, Litzow MR, et al. Peri-engraftment respiratory distress syndrome during autologous hematopoietic stem cell transplantation. Bone Marrow Transplant. 2001;27:1299–303. https://doi.org/10.1038/sj.bmt.1703075.

    Article  CAS  PubMed  Google Scholar 

  3. Wieruszewski PM, May HP, Peters SG, Gajic O, Hogan WJ, Dierkhising RA, et al. Characteristics and outcome of periengraftment respiratory distress syndrome after autologous hematopoietic cell transplant. Ann Am Thorac Soc. 2021;18:1013–9. https://doi.org/10.1513/AnnalsATS.202008-1032OC.

    Article  PubMed  Google Scholar 

  4. Chien JW, Madtes DK, Clark JG. Pulmonary function testing prior to hematopoietic stem cell transplantation. Bone Marrow Transplant. 2005;35:429–35. https://doi.org/10.1038/sj.bmt.1704783.

    Article  CAS  PubMed  Google Scholar 

  5. Ho VT, Weller E, Lee SJ, Alyea EP, Antin JH, Soiffer RJ. Prognostic factors for early severe pulmonary complications after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2001;7:223–9. https://doi.org/10.1053/bbmt.2001.v7.pm11349809.

    Article  CAS  PubMed  Google Scholar 

  6. Parimon T, Madtes DK, Au DH, Clark JG, Chien JW. Pretransplant lung function, respiratory failure, and mortality after stem cell transplantation. Am J Respir Crit Care Med. 2005;172:384–90. https://doi.org/10.1164/rccm.200502-212OC.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Carteaux G, Parfait M, Combet M, Haudebourg AF, Tuffet S, Mekontso Dessap A. Patient-self inflicted lung injury: a practical review. J Clin Med. 2021;10. https://doi.org/10.3390/jcm10122738.

  8. Jonkman AH, de Vries HJ, Heunks LMA. Physiology of the respiratory drive in ICU patients: implications for diagnosis and treatment. Crit Care. 2020;24:104. https://doi.org/10.1186/s13054-020-2776-z

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Funding

National Institute of Health / National Heart, Lung and Blood Institute Grant Number K23HL151671 (recipient: Hemang Yadav).

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

    Zhenmei Zhang & Hemang Yadav

  2. Department of Pharmacy, Mayo Clinic, Rochester, MN, USA

    Patrick M. Wieruszewski

  3. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    Mehrdad Hefazi Torghabeh & William J. Hogan

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  1. Zhenmei Zhang
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  2. Patrick M. Wieruszewski
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  3. Mehrdad Hefazi Torghabeh
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  4. William J. Hogan
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  5. Hemang Yadav
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Contributions

ZZ was responsible for extracting and analyzing data, interpreting results, and writing the manuscript. PMW designed the original protocol, extracted data and reviewed the manuscript. MHT and WJH contributed to the study design, and reviewed and edited the manuscript. HY was responsible for reviewing the study protocol, analyzing and interpreting data, and writing the manuscript.

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Correspondence to Zhenmei Zhang.

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Zhang, Z., Wieruszewski, P.M., Hefazi Torghabeh, M. et al. Pulmonary function and long-term survival in patients with PERDS after autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 58, 1289–1291 (2023). https://doi.org/10.1038/s41409-023-02101-5

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