Prognostic factors for early severe pulmonary complications after hematopoietic stem cell transplantation

Pulmonary complications are a significant cause of early mortality (before day 100) after bone marrow transplantation (BMT). To identify factors assoc iated with development of early post-BMT severe pulmonary complications (SP Cs), we conducted a retrospective review of the medical records of 339 cons ecutive patients who underwent hematopoietic stem cell transplantation for hematologic disorders and identified pulmonary complications that occurred before day 60 posttransplantation. SPCs, defined as (1) diagnosis of diffus e alveolar hemorrhage, (2) need for mechanical ventilation, or (3) death fr om respiratory failure, occurred in 48 (24%) of 199 patients receiving allo geneic transplants and 4 (2.9%) of 140 patients receiving autologous transp lants (P <.001). Multiple clinical variables were analyzed to determine the ir influence on the development of SPCs in allogeneic marrow recipients. Th e method of graft-versus-host disease (GVHD) prophylaxis was the single mos t important factor affecting SPC incidence. Of patients who received cyclos porine/methotrexate (CYA/MTX) as GVHD prophylaxis, 33% experienced SPCs com pared with 8% of those receiving T-cell depletion (TCD) alone (P <.0001). M ultivariate analysis confirmed that TCD was associated with a lower risk of SPCs (relative risk [RR], 0.18; P =.0006). In addition to GVHD prophylaxis , a reduced pretransplantation FEV1 (forced expiratory volume in 1 second) (less than or equal to 80% of predicted) was associated with an increased r isk for SPCs (odds ratio, 4.4; P =.0025). Grades 2 to 4 acute GVHD, tobacco use, age greater than or equal to 50 years, sex, unrelated donor, cytomega lovirus serologic status, disease status at transplantation, pretransplanta tion carbon monoxide diffusing capacity, and total body irradiation were no t associated with development of SPCs. We conclude that autologous BMT is a ssociated with a significantly lower incidence of SPCs compared with alloge neic BMT and that for allogeneic BMT, GVHD prophylaxis using TCD is associa ted with a significantly lower risk for SPCs compared with prophylaxis usin g CYA/MTX. Patients with pretransplantation FEV1 of less than or equal to 8 0% appear to have a higher risk for SPCs.