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Biol Blood Marrow Transplant. 2019 Oct;25(10):2024-2030. doi: 10.1016/j.bbmt.2019.06.004. Epub 2019 Jun 12.

Pulmonary Complications in Pediatric and Adolescent Patients Following Allogeneic Hematopoietic Cell Transplantation.

Author information

1
Department of pediatrics, Columbia University Medical Center, New York, New York.
2
National Marrow Donor Program/Be the Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota.
3
Department of pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
4
Department of hematology, Christian Medical College, Vellore, India.
5
Division of Pediatric-Blood & Marrow Transplantation, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina; Carolinas Cord Blood Bank, Durham, North Carolina.
6
Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
7
Blood and Marrow Transplant Program-Pediatrics, University of Minnesota, Minneapolis, Minnesota.
8
Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
9
Department of pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio.
10
Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: mpasquini@mcw.edu.

Abstract

Pulmonary complications after hematopoietic cell transplantation (HCT) can lead to significant morbidity and mortality. Limited evaluation of the true incidence of these complications in children and subsequent outcomes of these complications have not been evaluated recently. In April 2018, the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and the National Cancer Institute cosponsored a meeting of experts to describe the status of pulmonary complications in children after HCT, identify critical gaps in knowledge, and explore avenues for research to advance care and optimize outcomes. The Center for International Blood and Marrow Transplant Research was used to evaluate the cumulative incidence of pulmonary complications in children and their respective survival. Of the 5022 children included in this analysis who received allogeneic HCT from 2010 to 2016, 606 developed pulmonary complications within the first year after HCT. Pneumonitis occurred in 388 patients, 125 patients developed pulmonary hemorrhage, and 200 patients had lung graft-versus-host disease (GVHD). For those developing pulmonary complications within 1 year, overall survival 100 days after diagnosis of pulmonary complications was 49% (95% confidence interval [CI], 43% to 54%) for patients with pneumonitis, 23% (95% CI, 16% to 31%) in patients with pulmonary hemorrhage, and 87% (95% CI, 81% to 91%) in patients with pulmonary GVHD. This study demonstrates the approximate incidence of these complications, as well as their significant effects on survival, and can serve as a baseline for future research.

KEYWORDS:

Lung GVHD; Pediatrics; Pneumonitis; Pulmonary hemorrhage

PMID:
31201861
DOI:
10.1016/j.bbmt.2019.06.004

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