ARDS during haematopoietic reconstruction after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in non-child patients: based on the new global definition.
Chang Gao, Ying Wang, Di Yin, Daxiong Zeng, Ye Gao, Yu He, Yuanyuan Yang, Haiyan Wang, Depei Wu, Qiang Guo
{"title":"ARDS during haematopoietic reconstruction after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in non-child patients: based on the new global definition.","authors":"Chang Gao, Ying Wang, Di Yin, Daxiong Zeng, Ye Gao, Yu He, Yuanyuan Yang, Haiyan Wang, Depei Wu, Qiang Guo","doi":"10.1136/bmjresp-2024-002691","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Haematopoietic reconstitution is marked by immunosuppression and pancytopenia, representing the initial high-risk period following allogeneic haematopoietic stem cell transplantation (allo-HSCT). However, little is known about the occurrence of acute respiratory distress syndrome (ARDS) during haematopoietic reconstitution.</p><p><strong>Methods: </strong>This retrospective cohort study included 1024 patients who underwent allo-HSCT in Suzhou from 2016 to 2019. Clinical data and follow-up information were collected from medical records. ARDS was defined according to the new global definition established in 2023. The primary outcomes were the incidence of ARDS during haematopoietic reconstitution after allo-HSCT and 1 year post-transplantation mortality.</p><p><strong>Results: </strong>Among the 1024 patients, 58 (5.6%) died within 1 year after HSCT. ARDS during haematopoietic reconstitution occurred in 45 patients (4.4%), of whom 29 were treated with high-flow nasal oxygen only. The median onset of ARDS was 9.0 days post-transplantation. Patients who developed ARDS had a significantly higher risk of 1-year mortality after HSCT (HR 7.99, 95% CI 4.13 to 15.44). Independent risk factors for ARDS during haematopoietic reconstitution included longer intervals between disease onset and transplantation (OR 1.01, 95% CI 1.00 to 1.02), a greater number of previous HSCTs (OR 1.82, 95% CI 1.04 to 3.19), and higher red cell distribution width at admission (OR 1.12, 95% CI 1.02 to 1.22).</p><p><strong>Conclusions: </strong>According to the new 2023 global definition, ARDS during haematopoietic reconstitution is independently associated with increased 1-year mortality after allo-HSCT. Early identification of ARDS during this period is particularly important, and recognising its risk factors may aid in timely diagnosis and intervention.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359526/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Respiratory Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjresp-2024-002691","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Haematopoietic reconstitution is marked by immunosuppression and pancytopenia, representing the initial high-risk period following allogeneic haematopoietic stem cell transplantation (allo-HSCT). However, little is known about the occurrence of acute respiratory distress syndrome (ARDS) during haematopoietic reconstitution.
Methods: This retrospective cohort study included 1024 patients who underwent allo-HSCT in Suzhou from 2016 to 2019. Clinical data and follow-up information were collected from medical records. ARDS was defined according to the new global definition established in 2023. The primary outcomes were the incidence of ARDS during haematopoietic reconstitution after allo-HSCT and 1 year post-transplantation mortality.
Results: Among the 1024 patients, 58 (5.6%) died within 1 year after HSCT. ARDS during haematopoietic reconstitution occurred in 45 patients (4.4%), of whom 29 were treated with high-flow nasal oxygen only. The median onset of ARDS was 9.0 days post-transplantation. Patients who developed ARDS had a significantly higher risk of 1-year mortality after HSCT (HR 7.99, 95% CI 4.13 to 15.44). Independent risk factors for ARDS during haematopoietic reconstitution included longer intervals between disease onset and transplantation (OR 1.01, 95% CI 1.00 to 1.02), a greater number of previous HSCTs (OR 1.82, 95% CI 1.04 to 3.19), and higher red cell distribution width at admission (OR 1.12, 95% CI 1.02 to 1.22).
Conclusions: According to the new 2023 global definition, ARDS during haematopoietic reconstitution is independently associated with increased 1-year mortality after allo-HSCT. Early identification of ARDS during this period is particularly important, and recognising its risk factors may aid in timely diagnosis and intervention.
期刊介绍:
BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.