Infections Post Transplant
Bone Marrow Transplantation (2003) 32, 515–522. doi:10.1038/sj.bmt.1704162
Incidence, risk factors, and mortality from pneumonia developing late after hematopoietic stem cell transplantation
Supported in part by grants from The National Heart, Lung, and Blood Institute (HL36444) and The National Cancer Institute (CA15704, CA18029, CA18221, CA15704) of the National Institutes of Health, DHHS.
Chien-Shing Chen1,2, M Boeckh1, K Seidel1, J G Clark1, E Kansu1, D K Madtes1, J L Wagner1,3, R P Witherspoon1, C Anasetti1, F R Appelbaum1, W I Bensinger1, H J Deeg1, P J Martin1, J E Sanders1, R Storb1, J Storek1, J Wade1,4, M Siadak1, M E D Flowers1 and K M Sullivan1
1Clinical Research Division, Fred Hutchinson Cancer Research Center and the University of Washington, School of Medicine Seattle, WA, USA
Correspondence: Dr KM Sullivan, Division of Medical Oncology and Transplantation, Duke University Medical Center, Box 3476, Durham, NC 27710, USA. E-mail: sulli025@mc.duke.edu
2Current address: Division of Hematology/Oncology and Stem Cell and Bone Marrow Transplant Program, Loma Linda University Medical Center, Loma Linda, CA 92350, USA
3Current address: BMT Department, Thomas Jefferson University, 130 S 9th Street, Edison Bldg #400, Philadelphia, PA 19107, USA
4Current address: Medical College of Wisconsin, 9200 W Wisconsin Ave., FEC 3963A, Milwaukee, WI 53226, USA
Received 1 July 2002; Accepted 9 March 2003.
Abstract
The incidence, etiology, outcome, and risk factors for developing pneumonia late after hematopoietic stem cell transplantation (SCT) were investigated in 1359 patients transplanted in Seattle. A total of 341 patients (25% of the cohort) developed at least one pneumonic episode. No microbial or tissue diagnosis (ie clinical pneumonia) was established in 197 patients (58% of first pneumonia cases). Among the remaining 144 patients, established etiologies included 33 viral (10%), 31 bacterial (9%), 25 idiopathic pneumonia syndrome (IPS, 7%), 20 multiple organisms (6%), 19 fungal (6%), and 16 Pneumocystis carinii pneumonia (PCP) (5%). The overall cumulative incidence of first pneumonia at 4 years after discharge home was 31%. The cumulative incidences of pneumonia according to donor type at 1 and 4 years after discharge home were 13 and 18% (autologous/syngeneic), 22 and 34% (HLA-matched related), and 26 and 39% (mismatched related/unrelated), respectively. Multivariate analysis of factors associated with development of late pneumonia after allografting were increasing patient age (RR 0.5 for <20 years, 1.2 for >40 years, P=0.009), donor HLA-mismatch (RR 1.6 for unrelated/mismatched related, P=0.01), and chronic graft-versus-host disease (GVHD; RR 1.5, P=0.007). Our data suggest that extension of PCP prophylaxis may be beneficial in high-risk autograft recipients. Further study of long-term anti-infective prophylaxis based on patient risk factors after SCT appear warranted.
Keywords:
pneumonia, blood stem cell transplantation, late complications
