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- Title
Late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation: prognostic factors and treatments.
- Authors
Mo, X.‐D.; Zhang, X.‐H.; Xu, L.‐P.; Wang, Y.; Yan, C.‐H.; Chen, H.; Chen, Y.‐H.; Han, W.; Wang, F.‐R.; Wang, J.‐Z.; Liu, K.‐Y.; Huang, X.‐J.
- 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.
- Subjects
PNEUMONIA diagnosis; HEMATOPOIETIC stem cell transplantation; PNEUMONIA treatment; RISK factors of pneumonia; HEMATOLOGY; BRONCHOALVEOLAR lavage
- Publication
Transplant Infectious Disease, 2016, Vol 18, Issue 4, p492
- ISSN
1398-2273
- Publication type
Article
- DOI
10.1111/tid.12553