Pulmonary complications after hematopoietic stem cell transplant in children

Abstract

Background: Despite advances in transplantation and supportive care, a considerable number of patients still have poor prognosis with pulmonary complications (PCs) after hematopoietic stem cell transplant (HSCT). This retrospective study evaluated the clinical characteristics, outcomes, and prognostic factors of PCs in HSCT recipients followed-up for 2 years. Method: We retrospectively analyzed the medical records of 109 recipients of HSCT between 2010 and 2012. Results: In this study, 55 PC episodes developed in 38 recipients. Non-invasive diagnostic work-ups were preferred, including sputum examination, serology test, and chest computed tomography (85.5%, 72.7%, and 76.4%, respectively). Infection was the most commonly discovered etiology of PCs (61.8%). The incidence of PCs was lower in patients who received autologous transplantation than in those who received other type of transplantation (65.8% vs. 49.3%, p=0.009). Analysis of PCs and morbidities revealed that the mortality rate was 32.7% in 18 episodes that were closely related with multi-organ dysfunction syndrome (MODS) when the PCs were diagnosed (OR, 26.178

p = 0.001). Hematological dysfunction was the main factor for poor outcome in PCs (OR, 11.6

p = 0.03). Of the HSCT recipients with PCs, 41.8% were transferred to the pediatric intensive care unit (PICU) for respiratory failure, and the associated mortality rate was 73%. After PICU admission, continuous renal replacement therapy was significantly more commonly administered in patients who died than in those who survived (70.6% vs 16.7%, respectively

p = 0.041). Five patients with 16 fatal primary PCs after HSCT who survived showed lesser progress to MODS and received corticosteroid therapy for acute respiratory distress syndrome more frequently than did those who died. Conclusions: Physicians must closely observe for the existence of any other organ dysfunction in HSCT recipients with PCs, especially hematologic conditions. To manage MODS, early intervention with PICU admission should be considered.