Late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation: prognostic factors and treatments

Transpl Infect Dis. 2016 Aug;18(4):492-503. doi: 10.1111/tid.12553. Epub 2016 Aug 2.

Abstract

Background: In this study, we aimed to evaluate the prognostic factors associated with and treatments for late-onset severe pneumonia (LOSP) in patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods: Fifty consecutive patients who underwent non-T-cell-depleted allo-HSCT at the Peking University Institute of Hematology and met the criterion of LOSP after allo-HSCT were enrolled.

Results: The median time from allo-HSCT to the occurrence of LOSP was 231 (90-1487) days. Twenty-eight patients harbored 1 or more pathogens (infectious LOSP, I-LOSP), whereas 22 did not harbor any pathogens (non-infectious LOSP, NI-LOSP). The 100-day survival rate of LOSP patients was 31.1%. Patients smoking before allo-HSCT (0% vs. 35.4%, P = 0.002) and male gender (20.0% vs. 61.9%, P = 0.026) had lower 100-day survival rate. Patients with a lower bronchoalveolar lavage fluid (BALF) neutrophil percentage had higher 100-day survival rate relative to those with higher BALF neutrophil percentage (45.5% vs. 16.7%, P = 0.012). The 100-day survival rate of patients with I-LOSP was lower than that of patients with NI-LOSP (19.1% vs. 46.9%, P = 0.043). Patients given late (≥1 week after LOSP diagnosis) and low-dose methylprednisolone (MP) therapy (≤2 mg/kg/day) had the best 100-day survival rate. In the multivariate analysis, nonsmoking before allo-HSCT and late and low-dose MP therapy were significantly associated with a better survival after LOSP.

Conclusion: LOSP is a severe complication after allo-HSCT. The correct timing and corticosteroid dosage in the context of broad-spectrum antimicrobial therapy might further improve the outcomes of patients with LOSP.

Keywords: allogeneic hematopoietic stem cell transplantation; late-onset severe pneumonia; methylprednisone.

MeSH terms

  • Adolescent
  • Adult
  • Bronchoalveolar Lavage Fluid / cytology
  • Female
  • Follow-Up Studies
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / therapeutic use*
  • Graft vs Host Disease / prevention & control
  • HLA Antigens / immunology
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Hematopoietic Stem Cell Transplantation / mortality
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Pneumonia / drug therapy*
  • Pneumonia / etiology
  • Pneumonia / mortality*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Survival Rate
  • Transplantation Conditioning / methods
  • Transplantation, Homologous / adverse effects
  • Transplantation, Homologous / mortality
  • Young Adult

Substances

  • Glucocorticoids
  • HLA Antigens
  • Immunosuppressive Agents
  • Methylprednisolone