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Risk factors and prognosis of non-infectious pulmonary complications after allogeneic hematopoietic stem cell transplantation

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Abstract

Non-infectious pulmonary complications (NIPCs) following allogeneic hematopoietic stem cell transplantation (HSCT) are relatively rare, but frequently fatal. This study investigated the pre-transplant risk factors for developing NIPCs using Japanese transplant registry database entries from 2001 to 2009. Among 13,573 eligible patients, 535 experienced NIPCs (3.9%). Multivariate analysis identified high recipient age (60 + years: HR 1.85, P = 0.003), HLA mismatch (HR 1.61, P < 0.001), female to male HSCT (HR 1.54, P < 0.001), and unrelated bone marrow transplantation (UR-BMT) (HR 3.88, P < 0.001) as significantly associated with an increased risk of NIPCs. In contrast, a non-total body irradiation (TBI) regimen with reduced intensity conditioning (RIC) were associated with a decreased risk of NIPCs compared with a cyclophosphamide (CY) + TBI regimen (busulfan + CY: HR 0.67, P = 0.009, other non-TBI: HR 0.46, P < 0.001), fludarabine-based RIC (HR 0.52, P < 0.001), and other RIC (HR 0.42, P = 0.003). The mortality rate was significantly worse for patients with NIPCs than those without (HR 1.54, 71 P < 0.001). This large-scale retrospective study suggests that both allo-reactions to donor cells and conditioning regimen toxicity contributed to NIPCs following HSCT.

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Acknowledgements

The authors are grateful for the assistance and cooperation of all staff at the following collaborating institutes: the Japan Society for Hematopoietic Cell Transplantation (JSHCT), the Japanese Data Center for Hematopoietic Cell Transplantation.

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Authors and Affiliations

  1. Department of Hematology/Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan

    Makoto Onizuka

  2. Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Nobuharu Fujii

  3. Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan

    Hideki Nakasone

  4. Department of Hematology, Oita University Hospital, Oita, Japan

    Masao Ogata

  5. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  6. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

  7. Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan

    Ritsuro Suzuki

  8. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  9. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Kazuteru Ohashi

  10. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    Yukiyasu Ozawa

  11. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  12. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan

    Kazuhiro Ikegame

  13. Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Hirohisa Nakamae

  14. Department of Hematology/Oncology, Osaka Women’s and Children’s Hospital, Osaka, Japan

    Masami Inoue

  15. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

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  1. Makoto Onizuka
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  14. Takahiro Fukuda
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for the Transplant Complications Working Group of the Japan Society for Hematopoietic Cell Transplantation

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Correspondence to Makoto Onizuka.

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Onizuka, M., Fujii, N., Nakasone, H. et al. Risk factors and prognosis of non-infectious pulmonary complications after allogeneic hematopoietic stem cell transplantation. Int J Hematol 115, 534–544 (2022). https://doi.org/10.1007/s12185-021-03282-9

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  • DOI: https://doi.org/10.1007/s12185-021-03282-9

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