To describe the infectious pulmonary complications that develop in autologous HSCT recipients during the first 30 days after transplant.
In this prospective, observational study, we included all adults who had autologous HSCT in Mayo Medical Center. Confirmed bacterial pneumonia was defined by the growth of bacteria from respiratory specimen or pleural fluid in the appropriate clinical setting. If there was no growth of bacterial pathogen in the presence of the clinical criteria, the pneumonia was considered presumed. Fungal pneumonias were diagnosed according to International Consensus criteria described by Ascioglu et al.
Four hundred seventy HSCT recipients were enrolled in the study. Patients mean (SD) age was 54.6 (11.4) years; 61.5% were male and 93.4% were Caucasian. All but 7 patients had underlying hematologic malignancies. The source of stem cell was peripheral blood in 450 (95.7%). Pulmonary infections developed in 65 (13.8%) during the first 30 days following HSCT. These infections included presumed pneumonia (62), confirmed bacterial pneumonia (2), possible fungal pneumonia (2), probable fungal pneumonia (1) and probable pulmonary aspergillosis (1). The mean (SD) age of HSCT recipients with infection 58.1 (9.9) compared to 54.2 (11.3) of those without infection (P = 0.0094). There were no statistically significant differences in gender, ethnicity, graft source, and neutrophil engraftment period between patients with and without pulmonary infections.
Infectious pulmonary complications occur in about 14% of autologous HSCT recipients during the first month following transplant. The most common infectious pulmonary complication is presumed pneumonia. Fungal and viral pulmonary infections are uncommon during the first month after transplant. Old age appears to be a risk factor for the development of pulmonary infection.
Since fungal and viral pulmonary infections are uncommon during the first 30 days following HSCT, clinicians should focus on preventing and treating bacterial pulmonary complications.
Ahmed Mahmoud, None.