造血干细胞移植后限制性通气缺陷与死亡率增加相关。

IF 3.6 3区医学 Q2 HEMATOLOGY

Transplantation and Cellular Therapy Pub Date : 2025-02-05 DOI:10.1016/j.jtct.2025.02.001

Mansour Alkhunaizi , Felipe Soto-Lanza , Cheuk Hong Leung , Neel Bhan , Lara Bashoura , Burton F. Dickey , Husham Sharifi , Guang-Shing Cheng , Gregory A. Yanik , Gabriela Rondon , Rima Saliba , George Chen , Gheath Al-Atrash , Chitra Hosing , Partow Kebriaei , Uday R. Popat , Elizabeth J. Shpall , Richard E. Champlin , Liang Li , Amin M. Alousi , Ajay Sheshadri

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引用次数: 0

摘要

导语：造血细胞移植（HCT）有可能治愈血液系统恶性肿瘤，但尽管HCT治疗方案和移植物抗宿主病（GVHD）治疗取得了进展，但HCT后的并发症仍然是一个主要挑战。hct后肺损伤引起限制性通气缺陷（RVD）的流行病学尚未得到研究。本研究调查了HCT后新发RVD的发生率、病因以及对总生存期（OS）和非复发死亡率（NRM）的影响。方法：我们对1999年2月至2018年3月期间在德克萨斯大学MD安德森癌症中心接受首次同种异体HCT治疗原发性血液恶性肿瘤的成年患者进行了回顾性研究。结果：3030例患者中，hct前有50例RVD， hct后有1275例新发肺损伤，其中270例为新发RVD。hct后RVD最常见的原因是呼吸道感染（23%）、间质性肺疾病（15%）和截骨硬化（11%）。多因素分析显示年龄增加（HR 1.03 /年，95% CI 1.03-1.04）。结论：hct后新发RVD与死亡率增加相关。这些发现强调了通过主动肺功能监测识别RVD以改善hct后预后的重要性。

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Restrictive Ventilatory Defects Following Hematopoietic Stem Cell Transplant Are Associated With Increased Mortality

Introduction

Hematopoietic cell transplantation (HCT) can potentially cure hematologic malignancies, but despite advancements in HCT regimens and graft-versus-host disease (GVHD) management, post-HCT complications, remain a major challenge. The epidemiology of post-HCT pulmonary impairment causing restrictive ventilatory defect (RVD) has not been examined. This study investigates the incidence, etiology, and impact of new-onset RVD following HCT on overall survival (OS) and non-relapse mortality (NRM).

Methods

We conducted a retrospective review of adult patients who underwent their first allogeneic HCT for primary hematologic malignancies at The University of Texas MD Anderson Cancer Center between February 1999 and March 2018. RVD was defined by a total lung capacity (TLC) <5th percentile of the lower limit of normal. Patient data were analyzed using the Kaplan-Meier method, log-rank tests, and Cox regression models.

Results

Among 3030 patients, 50 had pre-HCT RVD and 1275 developed new pulmonary impairment post-HCT, of which, we found 270 cases of new-onset RVD. The most common causes of post-HCT RVD were respiratory tract infections (23%), interstitial lung disease (15%) and truncal sclerosis (11%). Multivariate analysis indicated increased age (HR 1.03 per year, 95% CI 1.03-1.04, P < .001), matched unrelated donor transplant (HR 1.29, 95% CI 1.04-1.60, P = .02), mismatched related transplant (HR 2.04, 95% CI 1.33-3.14, P = .001), cord blood stem cell source (HR 3.02, 95% CI 2.26-4.05, P < .001), RVD (HR 2.27, 95% CI 1.77-2.90, P < .001) and cGVHD (HR 1.72, 95% CI 1.44-2.05, P < .001) were associated with higher mortality. More severe restriction (HR 4.04, 95% CI 2.83-5.77, P < .001), progressive RVD (5.04, 95% CI 1.88-13.52, P = .001), and RVD onset within 1 year of HCT (HR 2.61, 95% CI 1.72-3.98, P < .001) were associated with higher mortality.

Conclusion

New-onset RVD post-HCT is associated with increased mortality. These findings emphasize the importance of identifying RVD through proactive pulmonary function monitoring to improve post-HCT outcomes.

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