SESSION TITLE: Post-Transplant Complications
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM
PURPOSE: Diffuse alveolar hemorrhage (DAH) in hematopoietic stem cell transplant (HSCT) recipients has been associated with mortality exceeding 70%. Over the last decade, the care of HSCT recipients has changed. We undertook this study to determine if there have been improvements in outcomes of HSCT recipients with DAH.
METHODS: We reviewed the electronic medical records of 2,628 patients who underwent 2,759 HSCT from 2002-2011 at Mayo Clinic in Rochester, MN. We defined DAH as evidence of bilateral pulmonary infiltrates with return from BAL becoming progressively bloodier or showing hemosiderin laden macrophages ≥ 20%, and no evidence of infection or other diagnosis. The post-transplant period was divided into peri-engraftement (0-30 days), early post-transplant (31-100 days), and late post-transplant (>100 days). Data were summarized as medians for continuous and percentages for categorical data. Comparisons between groups were made using Wilcoxon or chi square tests where appropriate. P values < 0.05 were considered statistically significant.
RESULTS: During the study period, 2,759 HSCTs were performed in 2,628 patients, 2,212 autologous and 453 allogeneic. Overall, DAH developed in 60 (2.3%) of transplant recipients. Amongst those recipients, allogeneic HSCT recipients were younger than their autologous counterparts, median age 49 years and 57 years, respectively, (p=0.04). In allogeneic recipients with DAH, total body irradiation (TBI) and non-myeloablative conditioning regimens were more commonly used (both p<0.001). Most of the DAH, 30 cases (50%), occurred during the peri-engraftment period. Corticosteroid therapy was used in 37 (62%) cases. The thirty-day and one-year mortality of DAH was 41% and 59%, respectively. There was no difference in hospital mortality outcome based on the use of corticosteroid therapy (p=0.99).
CONCLUSIONS: DAH continues to produce high mortality in HSCT recipients. Corticosteroid therapy does not appear to change hospital mortality. Prospective therapy studies should be performed to improve management of these patients.
CLINICAL IMPLICATIONS: Improvement in DAH management in a rapidly expanding patient population.
DISCLOSURE: The following authors have nothing to disclose: Raolat Abdulai, Rodrigo Cartin-Ceba
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