Frédéric Schlemmer1, Sylvie Chevret2, Gwenaël Lorillon1, Cédric De Bazelaire3, Régis Peffault de Latour4, Véronique Meignin5, Mauricette Michallet6, Eric Hermet7, Benjamin Wyplosz8, Véronique Houdouin9, Sylvain Marchand-Adam10, Gérard Socié4, Abdellatif Tazi11, Anne Bergeron12. 1. Univ Paris Diderot, Sorbonne Paris-Cité, AP-HP, Hôpital Saint-Louis, Service de Pneumologie, F-75010 Paris, France. 2. Biostatistics and Clinical Epidemiology Research Team (ECSTRA), UMR 1153 INSERM, Univ Paris Diderot, Sorbonne Paris Cité, France; Univ Paris Diderot, Sorbonne Paris-Cité, Département de Biostatistique et Informatique Médicale, AP-HP, Hôpital Saint Louis, Paris, France. 3. Univ Paris Diderot, Sorbonne Paris-Cité, Service de Radiologie, AP-HP, Hôpital Saint Louis, Paris, France. 4. Univ Paris Diderot, Sorbonne Paris-Cité, Hématologie-Greffe, APHP, Hôpital Saint-Louis, Paris, France. 5. Univ Paris Diderot, Sorbonne Paris-Cité, Pathologie, APHP, Hôpital Saint-Louis, Paris, France. 6. Centre Hospitalier Lyon Sud, Hématologie, Hospices Civils de Lyon, France. 7. Service de Thérapie Cellulaire et d'hématologie Clinique Adulte, Université d'Auvergne CREaT - EA 7283, INSERM CIC-501, CHU Clermont-Ferrand Hôpital Estaing, France. 8. Service des Maladies Infectieuses et Tropicales, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France. 9. Univ Paris Diderot, Sorbonne Paris-Cité, Service des Maladies Digestives et Respiratoires de l'Enfant, AP-HP, Hôpital Robert Debré, Paris, France. 10. Univ François Rabelais, INSERM UMR 1100, Centre d'Etude des Pathologies Respiratoires, CHRU de Tours, Service de Pneumologie, F-37000 Tours, France. 11. Univ Paris Diderot, Sorbonne Paris-Cité, AP-HP, Hôpital Saint-Louis, Service de Pneumologie, F-75010 Paris, France; Biostatistics and Clinical Epidemiology Research Team (ECSTRA), UMR 1153 INSERM, Univ Paris Diderot, Sorbonne Paris Cité, France. 12. Univ Paris Diderot, Sorbonne Paris-Cité, AP-HP, Hôpital Saint-Louis, Service de Pneumologie, F-75010 Paris, France; Biostatistics and Clinical Epidemiology Research Team (ECSTRA), UMR 1153 INSERM, Univ Paris Diderot, Sorbonne Paris Cité, France. Electronic address: anne.bergeron-lafaurie@sls.aphp.fr.
Abstract
BACKGROUND: Various late-onset noninfectious pulmonary complications may occur after allogeneic hematopoietic stem cell transplantation (HSCT). Interstitial lung diseases (ILD) are often overlooked, and few data are available. METHODS: We retrospectively analyzed the clinical features, pulmonary function tests, radiological features and outcomes of allogeneic HSCT recipients who were diagnosed with a noninfectious ILD and were managed in our center between 2001 and 2010. RESULTS: Forty patients were analyzed. The median time from transplant to ILD was 11.3 months. The donor hematopoietic stem cell source was peripheral blood stem cells in 75% of the cases. Seventy percent of the patients had extra-thoracic chronic graft versus host disease at ILD diagnosis. We identified two lung computed tomography (CT) scan patterns according to the predominance of ground glass opacities or alveolar consolidations. Restrictive ventilatory defect was the main pulmonary function pattern. Lung histology was available for seven patients and showed diffuse alveolar damage, non-specific interstitial pneumonia, organizing pneumonia or lymphoid interstitial pneumonia. Thirty-five patients (87.5%) were treated with systemic steroids. Thirteen patients died (32.5%), 10 of respiratory failure. The median survival rate at 24 months was 61%. CONCLUSION: This study highlights the existence of noninfectious post-allogeneic HSCT ILD and provides new insights into the characteristics of these illnesses.
BACKGROUND: Various late-onset noninfectious pulmonary complications may occur after allogeneic hematopoietic stem cell transplantation (HSCT). Interstitial lung diseases (ILD) are often overlooked, and few data are available. METHODS: We retrospectively analyzed the clinical features, pulmonary function tests, radiological features and outcomes of allogeneic HSCT recipients who were diagnosed with a noninfectious ILD and were managed in our center between 2001 and 2010. RESULTS: Forty patients were analyzed. The median time from transplant to ILD was 11.3 months. The donor hematopoietic stem cell source was peripheral blood stem cells in 75% of the cases. Seventy percent of the patients had extra-thoracic chronic graft versus host disease at ILD diagnosis. We identified two lung computed tomography (CT) scan patterns according to the predominance of ground glass opacities or alveolar consolidations. Restrictive ventilatory defect was the main pulmonary function pattern. Lung histology was available for seven patients and showed diffuse alveolar damage, non-specific interstitial pneumonia, organizing pneumonia or lymphoid interstitial pneumonia. Thirty-five patients (87.5%) were treated with systemic steroids. Thirteen patients died (32.5%), 10 of respiratory failure. The median survival rate at 24 months was 61%. CONCLUSION: This study highlights the existence of noninfectious post-allogeneic HSCT ILD and provides new insights into the characteristics of these illnesses.
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