Respiratory Care |

Pulmonary Complications Following Allogeneic-Hematopoietic Stem Cell Transplantation at a High-Volume, Academic Transplant Center FREE TO VIEW

Bianca Harris, MS; Sejal Morjaria; Littman Eric; Sergio Giralt; Diane Stover; Ying Taur, MPH; Pamer Eric
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Medicine/Pulmonary, Memorial Sloan Kettering Cancer Center, New York, NY

Chest. 2014;146(4_MeetingAbstracts):916A. doi:10.1378/chest.1994464
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SESSION TITLE: Respiratory Infections Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary complications cause significant morbidity and mortality following allogeneic hematopoietic stem cell transplantation (HSCT). Diagnostic chest imaging is an essential tool for evaluating infectious or inflammatory processes involving the lung parenchyma in the post-transplant setting. The incidence, risk factors and outcomes associated with abnormal parenchymal findings have not been well-characterized.

METHODS: A retrospective chart review was performed on an established cohort of 94 patients who underwent allogeneic HSCT at MSKCC between September 4, 2009, and August 4, 2011. Data collection included results of clinically-indicated chest CT imaging, diagnostic laboratory tests, and documented clinical impressions and outcomes over 3 years of follow-up. The primary endpoint, pulmonary complication (PC), was defined as the first abnormal parenchymal finding (airspace, ground glass, nodular or interstitial opacities) identified on diagnostic imaging between transplant admission and study end or death. Abnormalities present on baseline imaging pre-transplant were excluded. Relationships between transplant-factors, PCs and clinical outcomes were evaluated.

RESULTS: 67/94 (71%) of patients who underwent HSCT during the study period developed at least one PC, of which 31 (46%) and 61 (91%) occurred during the first post-transplant month and year, respectively. The majority had received umbilical cord (18, 27%) or T-cell depleted peripheral (30, 45%) SCTs, and nearly half were diagnosed as having pneumonia. On univariate analysis, cord SCT conferred an increased risk of PC prior to stem cell engraftment (OR 4.9; p=0.002) while recipients of HLA-matched donor cells were less likely to have a pre-engraftment PC (OR 0.3; p=0.007). Multivariate analysis showed that a PC at any time post-HSCT more than doubled the risk of death (OR 2.6; p = 0.046).

CONCLUSIONS: This study demonstrates a high incidence of PCs and associated mortality in a cohort representative of the allogeneic HSCT population at our high-volume transplant center. Findings also suggest that recipients of cord or modified SCTs may be at greater risk for developing PCs, perhaps due to intensified or prolonged immunosuppression as compared to conventional SCT recipients. Prospective investigation is warranted to target interventions in highest risk groups.

CLINICAL IMPLICATIONS: An improved understanding of clinical and diagnostic features of PCs will advance our ability to identify, treat and prevent these life-threatening complications.

DISCLOSURE: The following authors have nothing to disclose: Bianca Harris, Sejal Morjaria, Littman Eric, Sergio Giralt, Diane Stover, Ying Taur, Pamer Eric

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