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Incidence and predictors of idiopathic pneumonia syndrome in hematopoietic stem cell transplant patients: a nationwide registry study

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Abstract

Idiopathic pneumonia syndrome (IPS) is a rare but deadly complication of hematopoietic stem cell transplantation (HSCT). This study characterized the incidence and risk factors for IPS after HSCT in Taiwan. Data from January 2009 to February 2019 was collected from the Taiwan Society of BMT national registry. Forty-three (1.1%) of 3924 HSCT patients who developed IPS were identified. Incidence of IPS was lower in patients who received autologous HSCT than patients who received allogeneic HSCT (0.68% vs 1.44%, P = 0.022). Multivariate analysis showed that use of TBI and intravenous busulfan in the conditioning regimen were each independent predictor of IPS after HSCT. In addition, development of IPS was significantly associated with increased risk of death in the first 120 days post-HSCT (HR, 2.09; 95% CI, 1.08 to 4.05, P = 0.029) and 2 years post-HSCT (HR, 1.65; 95% CI, 1.07 to 2.542, P = 0.023), but not beyond 2 years post-HSCT. However, survival outcomes did not differ significantly between patients with IPS who received autologous versus allogeneic HSCT (P = 0.52). In conclusion, despite the relatively low incidence of post-HSCT IPS in Taiwan, mortality remains high. The results of this study will help to identify high-risk patients for early intervention and guide future therapeutic research.

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Acknowledgements

The authors thank all the patients and hospitals who participated in this study. The authors acknowledge the Taiwan Society of Blood and Marrow Transplantation for data collection and registry.

Funding

Supported by grants from the National Taiwan University Hospital (NTUH 110-T05, 111-S0028 [to H–H.C.]) and the Ministry of Science and Technology, Taiwan (MOST 109–2314-B-002–129, 110–2314-B-002–088-MY3 [to H–H.C.]).

Author information

Author notes

  1. Michael A. Liu, Chien-Chang Lee authors contributed equally to the work.

Authors and Affiliations

  1. Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Michael A. Liu, Quan Phung, Quynh-Lan Dao & Babak Tehrani

  2. Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

    Chien-Chang Lee

  3. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

    Ming Yao & Chi-Cheng Li

  4. Department of Pediatrics, China Medical University Children’s Hospital, Taichung, Taiwan

    Kang-Hsi Wu

  5. Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Tsung-Chih Chen

  6. Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Jyh-Pyng Gau

  7. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

    Sin-Syue Li

  8. Department of Internal Medicine, Linkou Branch, Chang Gung Memorial Hospital, Taoyun, Taiwan

    Po-Nan Wang

  9. Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Yi-Chang Liu

  10. Department of Hematology and Oncology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan

    Tso-Fu Wang

  11. Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan

    Lun-Wei Chiou

  12. Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan

    Ming-Yang Lee

  13. Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Ming-Sun Yu

  14. Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan

    Chuan-Cheng Wang

  15. Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Shih-Chiang Lin

  16. Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan

    Yeu-Chin Chen

  17. Department of Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan

    Tsu-Yi Chao

  18. Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan

    Ming-Chun Ma

  19. Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Chih-Cheng Chen

  20. Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 8 Chung-Shan South Road, Taipei, 10041, Taiwan

    Hsiu-Hao Chang

Authors
  1. Michael A. Liu
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  2. Chien-Chang Lee
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  3. Quan Phung
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  4. Quynh-Lan Dao
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  6. Ming Yao
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  7. Chi-Cheng Li
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  11. Sin-Syue Li
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  13. Yi-Chang Liu
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  16. Ming-Yang Lee
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  22. Ming-Chun Ma
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  24. Hsiu-Hao Chang
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Contributions

All authors participated substantially in the manuscript and meet the ICMJE: authorship criteria. MAL: Conceptualization, Writing—original draft, Writing—reviewing and editing. CC-Lee: Conceptualization, Writing—original draft, Writing—reviewing and editing. QP, BT, QLD: Writing—reviewing and editing. MY, CC-Li, KHW, TCC, JPG, SSL, PNW, YCL, TFW, LWC, MYL, MSY, CCW, SCL, YCC, TYC, MCM, CCC: Acquisition, analysis, and interpretation of data. HHC: Conceptualization, Writing—original draft, Writing—reviewing and editing, Supervision.

Corresponding author

Correspondence to Hsiu-Hao Chang.

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Liu, M.A., Lee, CC., Phung, Q. et al. Incidence and predictors of idiopathic pneumonia syndrome in hematopoietic stem cell transplant patients: a nationwide registry study. Int J Hematol 116, 770–777 (2022). https://doi.org/10.1007/s12185-022-03417-6

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  • DOI: https://doi.org/10.1007/s12185-022-03417-6

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