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Transplantation |

Late-Onset Noninfectious Pulmonary Complications After Pediatric Allogeneic Hematopoietic Stem Cell Transplantation

Jong-seo Yoon, MD; Hwan Soo Kim, MD; Jae Wook Lee, MD; Yoon Hong Chun, MD; Nack Gyun Chung, MD; Hyun Hee Kim, MD; Bin Cho, MD; Hack Ki Kim, MD; Joon Sung Lee, MD
Author and Funding Information

The Catholic University of Korea, Seoul, Republic of Korea


Chest. 2014;145(3_MeetingAbstracts):639A. doi:10.1378/chest.1800289
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Abstract

SESSION TITLE: Transplantation

SESSION TYPE: Slide Presentations

PRESENTED ON: Sunday, March 23, 2014 at 12:15 PM - 01:15 PM

PURPOSE: In order to identify the characteristics of late-onset non-infectious pulmonary complications (LONIPCs) in children who have undergone allogeneic hematopoietic stem cell transplantation (HSCT), we retrospectively evaluated the incidence, characteristics, and outcomes of LONIPCs in these patients.

METHODS: We retrospectively reviewed the medical records of patients who underwent allogeneic HSCT at the Seoul Saint Mary’s Hospital between January 1, 2007 and December 31, 2010 (48 months) aged between 6 and 17 years at the time of transplantation. Pulmonary function test (PFT) and high-resolution computerized tomography (HRCT) were performed when symptoms and signs were suspected to be due to LONIPC and unexplained by infection. From November 2009, a routine PFT was performed 1 week before transplantation and 3, 6, 9, and 12 months after transplantation for early diagnosis of LONIPCs. Bronchiolitis obliterans (BO) was diagnosed on the basis of persistent radiographic changes consistent with BO in HRCT. BO with organizing pneumonia (BOOP) was diagnosed when there were appropriate HRCT findings without clinical evidence of infection by bronchoalveolar lavage or other tests.

RESULTS: Of the 103 patients, 17 (16.5%) developed LONIPCs, including 10 and 7 diagnosed with BO and BOOP, respectively. Univariate analyses revealed that the risk for the development of LONIPCs was higher in female donor/male recipients, recipients receiving myeloablative conditioning, those who experienced grade 3 acute graft-versus-host disease, and those with chronic GvHD (cGvHD). Multivariate analysis revealed that the only predictive factor for the development of LONIPCs was cGvHD. When the patients who developed cGvHD were analyzed separately, a shorter time to the development of cGvHD in sites besides the lungs after transplantation was a risk factor for developing LONIPCs.

CONCLUSIONS: The present study verifies the increasing incidence and prevalence rate of LONIPCs after HSCT in children. cGvHD was reconfirmed as a risk factor associated with LONIPC development. In addition, for the first time, the early development of cGvHD in sites besides the lungs was indicated to be a risk factor of LONIPCs.

CLINICAL IMPLICATIONS: These findings may establish new approaches for diagnosing, monitoring, treating, and investigating LONIPCs that significantly deteriorate and reduce quality of life and life expectancy.

DISCLOSURE: The following authors have nothing to disclose: Jong-seo Yoon, Hwan Soo Kim, Jae Wook Lee, Yoon Hong Chun, Nack Gyun Chung, Hyun Hee Kim, Bin Cho, Hack Ki Kim, Joon Sung Lee

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