OBJECTIVE: To analyze the clinical characteristics of the late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: A retrospective study was conducted in patients diagnosed as late-onset severe pneumonia after allo-HSCT from March, 2009 to January, 2013 in People's Hospital of Peking University. RESULTS: Of 1538 patients receiving allo-HSCT, 20 developed late-onset severe pneumonia with an incidence rate of 1.3%. Among the 20 patients, 17(85%) had human leukocyte antigen (HLA) identical donors. The other 3(15%) patients had received haplo-identical transplantation. Severe pneumonia occurred at a median time of 227(150-690) days after allo-HSCT. Blood gas tests showed that 14 patients (70%) had arterial oxygen lower than 60 mm Hg (1 mm Hg = 0.133 kPa). All patients had abnormal findings in chest X-ray or CT scan images, 18 (90%) of whom represented bilateral infiltrative lesions. None of the patients had evidence of active graft-versus-host disease before or during pneumonia. Eighteen patients did not respond to empiric antibiotics, neither did 8 patients to targeted medications who had positive pathogens by culture. Eleven patients died of respiratory failure and 9 survived. Six patients received donor lymphocyte infusion (DLI), 4 of whom obtained improvement of chest images and 3 survived till the end of follow-up. CONCLUSIONS: The late-onset severe pneumonia after allo-HSCT represents an aggressive behavior with poor prognosis. DLI might be an effective way to improve its outcome.
OBJECTIVE: To analyze the clinical characteristics of the late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: A retrospective study was conducted in patients diagnosed as late-onset severe pneumonia after allo-HSCT from March, 2009 to January, 2013 in People's Hospital of Peking University. RESULTS: Of 1538 patients receiving allo-HSCT, 20 developed late-onset severe pneumonia with an incidence rate of 1.3%. Among the 20 patients, 17(85%) had human leukocyte antigen (HLA) identical donors. The other 3(15%) patients had received haplo-identical transplantation. Severe pneumonia occurred at a median time of 227(150-690) days after allo-HSCT. Blood gas tests showed that 14 patients (70%) had arterial oxygen lower than 60 mm Hg (1 mm Hg = 0.133 kPa). All patients had abnormal findings in chest X-ray or CT scan images, 18 (90%) of whom represented bilateral infiltrative lesions. None of the patients had evidence of active graft-versus-host disease before or during pneumonia. Eighteen patients did not respond to empiric antibiotics, neither did 8 patients to targeted medications who had positive pathogens by culture. Eleven patients died of respiratory failure and 9 survived. Six patients received donor lymphocyte infusion (DLI), 4 of whom obtained improvement of chest images and 3 survived till the end of follow-up. CONCLUSIONS: The late-onset severe pneumonia after allo-HSCT represents an aggressive behavior with poor prognosis. DLI might be an effective way to improve its outcome.