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Chest Infections |

Pulmonary Complications and Mortality Following Hematopoietic Stem Cell Transplant in Adult Patients - 1 Year Follow-up

Khalid Alhourani*, MBBS; Rodney Folz, MD
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University of Louisville, Louisville, KY


Chest. 2012;142(4_MeetingAbstracts):188A. doi:10.1378/chest.1388737
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Abstract

SESSION TYPE: AIDS/ Immunocompromised Patients Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: High dose chemotherapy followed by hematopoietic stem cell transplant (HSCT) is frequently performed to treat a variety of malignant and non-malignant conditions. Pulmonary complications following HSCT have been frequently described. We performed a large comprehensive review to evaluate and characterize pulmonary complications occurring within 1 year of HSCT.

METHODS: We performed a retrospective review of 550 adult patients who underwent HSCT at Duke University Medical Center over a period of three and one-half years. All pulmonary complications that occurred within one year of follow-up were noted. Pulmonary complications were determined by review of all clinical data in each patient chart. Criteria for each diagnosis were based on published standards and determined prior to chart review. Sub-group analyses of complications were performed for autologous (Auto), allogeneic (Allo), and mini (Mini) HSCT.

RESULTS: Overall, there was 36% mortality (199 patients) during first year following HSCT. Pulmonary complications directly caused or significantly contributed to death in 60 of those (30%). First year all-causes mortality was inversely related to age group and pulmonary mortality was significantly higher in patients younger than 45 years old compared to patients older than 45. Pulmonary parenchymal complications included interstitial pneumonitis (IP) (23%), diffuse alveolar hemorrhage (5%), pulmonary edema (5%) and other parenchymal disorders (2%). Pleural effusions occurred in 9% and pulmonary vascular disease 1%. Pulmonary infections included fungal pneumonias (5%), viral pneumonias (5%); bacterial pneumonias (2%); and non-specified pulmonary infections (7%). With the exception of IP, pulmonary complications were less frequent following Auto-HSCT compared to Allo-HSCT.

CONCLUSIONS: Pulmonary complications are a major cause of morbidity and mortality during the first year following HSCT. Mortality related to pulmonary complications was found to be higher in younger patients than middle age and elderly patients.

CLINICAL IMPLICATIONS: Close pulmonary follow-up of patients who have undergone HSCT is warranted. Early diagnostic intervention should consider a broad differential diagnoses to include both infectious and non-infectious etiologies.

DISCLOSURE: The following authors have nothing to disclose: Khalid Alhourani, Rodney Folz

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University of Louisville, Louisville, KY

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