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Transplant Toxicities

Low-, medium- and high-dose steroids with or without aminocaproic acid in adult hematopoietic SCT patients with diffuse alveolar hemorrhage

Bone Marrow Transplantation volume 50, pages 420–426 (2015)Cite this article

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Abstract

Diffuse alveolar hemorrhage (DAH) is a poorly understood complication of transplantation carrying a high mortality. Patients commonly deteriorate and require intensive care unit (ICU) admission. Treatment with high-dose steroids and aminocaproic acid (ACA) has been suggested. The current study examined 119 critically ill adult hematopoietic transplant patients treated for DAH. Patients were subdivided into low-, medium- and high-dose steroid groups with or without ACA. All groups had similar baseline characteristics and severity of illness scores. Primary objectives were 30, 60, 100 day, ICU and hospital mortality. Overall mortality (n=119) on day 100 was high at 85%. In the steroids and ACA cohort (n=82), there were no significant differences in 30, 60, 100, day, ICU and hospital mortality between the dosing groups. In the steroids only cohort (n=37), the low-dose steroid group had a lower ICU and hospital mortality (P=0.02). Adjunctive treatment with ACA did not produce differences in outcomes. In the multivariate analysis, medium- and high-dose steroids were associated with a higher ICU mortality (P=0.01) as compared with the low-dose group. Our data suggest that treatment strategies may need to be reanalyzed to avoid potentially unnecessary and potentially harmful therapies.

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Acknowledgements

We would like to thank Vandita Joshi and Rose Erfe for their assistance with data collection and review of the manuscript, and Arthur Gelmis for his editorial assistance. This research is supported in part by the National Institutes of Health through M.D. Anderson's Cancer Center Support Grant CA016672.

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Authors and Affiliations

  1. Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    N K Rathi, A Dinh, S A Haque, K J Price & J L Nates

  2. Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    A R Tanner

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    W Dong, L Feng & J Ensor

  4. Department of Clinical Analytics and Informatics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    S K Wallace

  5. Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    G Rondon & U Popat

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  1. N K Rathi
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Correspondence to N K Rathi.

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Rathi, N., Tanner, A., Dinh, A. et al. Low-, medium- and high-dose steroids with or without aminocaproic acid in adult hematopoietic SCT patients with diffuse alveolar hemorrhage. Bone Marrow Transplant 50, 420–426 (2015). https://doi.org/10.1038/bmt.2014.287

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