Pulmonary complications post allogeneic haematopoietic stem cell transplant in children

IF 4.6 2区医学 Q2 IMMUNOLOGY

Clinical & Translational Immunology Pub Date : 2024-09-17 DOI:10.1002/cti2.70003

Hannah Walker, Joanne Abbotsford, Gabrielle M Haeusler, Daniel Yeoh, Shanti Ramachandran, Michelle Ng, Jonathan Holzmann, Shivanthan Shanthikumar, Heather Weerdenburg, Diane Hanna, Melanie R Neeland, Theresa Cole

{"title":"Pulmonary complications post allogeneic haematopoietic stem cell transplant in children","authors":"Hannah Walker, Joanne Abbotsford, Gabrielle M Haeusler, Daniel Yeoh, Shanti Ramachandran, Michelle Ng, Jonathan Holzmann, Shivanthan Shanthikumar, Heather Weerdenburg, Diane Hanna, Melanie R Neeland, Theresa Cole","doi":"10.1002/cti2.70003","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>Haematopoietic stem cell transplant (HCT) is a cellular therapy that, whilst curative for a child's underlying disease, carries significant risk of mortality, including because of pulmonary complications. The aims of this study were to describe the burden of pulmonary complications post-HCT in a cohort of Australian children and identify risk factors for the development of these complications.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Patients were identified from the HCT databases at two paediatric transplant centres in Australia. Medical records were reviewed, and demographics, HCT characteristics and pulmonary complications documented. Relative risk ratio was used to identify risk factors for developing pulmonary complications prior to first transplant episode, and survival analysis performed to determine hazard ratio.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In total, 243 children underwent transplant during the study period, and pulmonary complications occurred in 48% (117/243) of children. Infectious complications were more common (55%) than non-infective complications (18%) and 26% of patients developed both. Risk factors for the development of pulmonary complications included the following: diagnoses of MPAL (RR 2.16, <i>P</i> = 0.02), matched unrelated donor (RR1.34, <i>P</i> = 0.03), peripheral blood (RR 1.36, <i>P</i> = 0.028) or cord blood (RR 1.73, <i>P</i> = 0.012) as the stem cell source and pre-existing lung disease (RR1.72, <i>P</i> < 0.0001). Children with a post-HCT lung complication had a significantly increased risk of mortality compared with those who did not (HR 3.9, <i>P</i> < 0.0001).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This study demonstrates pulmonary complications continue to occur frequently in children post-HCT and contribute significantly to mortality. Highlighting the need for improved strategies to identify patients at risk pre-transplant and enhanced treatments for those who develop lung disease.</p>\n </section>\n </div>","PeriodicalId":152,"journal":{"name":"Clinical & Translational Immunology","volume":"13 9","pages":""},"PeriodicalIF":4.6000,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cti2.70003","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical & Translational Immunology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cti2.70003","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

Haematopoietic stem cell transplant (HCT) is a cellular therapy that, whilst curative for a child's underlying disease, carries significant risk of mortality, including because of pulmonary complications. The aims of this study were to describe the burden of pulmonary complications post-HCT in a cohort of Australian children and identify risk factors for the development of these complications.

Methods

Patients were identified from the HCT databases at two paediatric transplant centres in Australia. Medical records were reviewed, and demographics, HCT characteristics and pulmonary complications documented. Relative risk ratio was used to identify risk factors for developing pulmonary complications prior to first transplant episode, and survival analysis performed to determine hazard ratio.

Results

In total, 243 children underwent transplant during the study period, and pulmonary complications occurred in 48% (117/243) of children. Infectious complications were more common (55%) than non-infective complications (18%) and 26% of patients developed both. Risk factors for the development of pulmonary complications included the following: diagnoses of MPAL (RR 2.16, P = 0.02), matched unrelated donor (RR1.34, P = 0.03), peripheral blood (RR 1.36, P = 0.028) or cord blood (RR 1.73, P = 0.012) as the stem cell source and pre-existing lung disease (RR1.72, P < 0.0001). Children with a post-HCT lung complication had a significantly increased risk of mortality compared with those who did not (HR 3.9, P < 0.0001).

Conclusion

This study demonstrates pulmonary complications continue to occur frequently in children post-HCT and contribute significantly to mortality. Highlighting the need for improved strategies to identify patients at risk pre-transplant and enhanced treatments for those who develop lung disease.

Abstract Image

查看原文本刊更多论文

儿童异基因造血干细胞移植后的肺部并发症

目的造血干细胞移植（HCT）是一种细胞疗法，虽然可以治愈儿童的潜在疾病，但却有很大的死亡风险，包括肺部并发症。本研究旨在描述澳大利亚儿童组群中造血干细胞移植后肺部并发症的负担，并确定这些并发症发生的风险因素。方法从澳大利亚两家儿科移植中心的 HCT 数据库中确定患者。审查病历，记录人口统计学特征、HCT特征和肺部并发症。采用相对风险比确定首次移植前出现肺部并发症的风险因素，并进行生存分析以确定危险比。结果在研究期间，共有 243 名儿童接受了移植手术，其中 48% 的儿童（117/243）出现了肺部并发症。感染性并发症（55%）比非感染性并发症（18%）更常见，26%的患者同时出现感染性并发症和非感染性并发症。出现肺部并发症的风险因素包括：诊断为MPAL（RR 2.16，P = 0.02），匹配的非亲属捐赠者（RR 1.34，P = 0.03），干细胞来源为外周血（RR 1.36，P = 0.028）或脐带血（RR 1.73，P = 0.012），以及原有肺部疾病（RR 1.72，P <0.0001）。造血干细胞移植后出现肺部并发症的儿童与未出现并发症的儿童相比，死亡风险明显增加（HR 3.9，P < 0.0001）。结论本研究表明，儿童造血干细胞移植后肺部并发症仍会频繁发生，并严重影响死亡率。因此需要改进策略，在移植前识别高危患者，并加强对肺部疾病患者的治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical & Translational Immunology Medicine-Immunology and Allergy

CiteScore

12.00

自引率

1.70%

发文量

审稿时长

13 weeks

期刊介绍： Clinical & Translational Immunology is an open access, fully peer-reviewed journal devoted to publishing cutting-edge advances in biomedical research for scientists and physicians. The Journal covers fields including cancer biology, cardiovascular research, gene therapy, immunology, vaccine development and disease pathogenesis and therapy at the earliest phases of investigation.