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Prepublished online as a Blood First Edition Paper on July 10, 2003; DOI 10.1182/blood-2003-05-1597.
Submitted May 19, 2003
Accepted June 25, 2003
Risks and outcomes of idiopathic pneumonia syndrome after nonmyeloablative compared to conventional conditioning regimens for allogeneic hematopoietic stem cell transplantation
Takahiro Fukuda, Robert C Hackman, Katherine A Guthrie, Brenda M Sandmaier, Michael Boeckh, Michael B Maris, David G Maloney, H Joachim Deeg, Paul J Martin, Rainer F Storb, and David K Madtes*
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, School of Medicine, Seattle, WA, USA
Departments of Pathology and Laboratory Medicine, University of Washington, School of Medicine, Seattle, WA, USA
* Corresponding author; email: dmadtes{at}fhcrc.org.
Idiopathic pneumonia syndrome (IPS) is a significant non-infectious complication of hematopoietic stem cell transplantation (HCT). We compared the incidences and outcomes of IPS among patients given allogeneic HCT after nonmyeloablative (n=183) versus conventional (n=917) conditioning between December 1997 and December 2001. Patients given nonmyeloablative conditioning were older than those given conventional conditioning (median age, 53 vs. 41 years, p=0.001). The cumulative incidence of IPS was significantly lower at 120 days after nonmyeloablative compared to conventional conditioning (2.2% vs. 8.4%, p=0.003). In addition, greater patient age (>40 years), diagnosis of acute leukemia or myelodysplastic syndrome, and severe acute graft-versus-host disease were associated with significantly increased risks for IPS. Among older patients (>40 years) given conventional conditioning, high-dose total body irradiation (TBI) was associated with an increased risk of IPS compared to non-TBI-based regimens (16% vs. 5.8%, p=0.001). IPS occurred early after transplant, progressed rapidly, and was associated with a high mortality rate (75%) despite aggressive support. Initiation of mechanical ventilation and the presence of renal insufficiency at IPS onset were associated with increased risks for death after IPS. These findings support the concept that lung damage from the conditioning regimen plays a crucial role in the development of IPS after HCT.
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