造血干细胞移植后非结核性分枝杆菌肺部感染的临床特征和预后：一项回顾性队列研究

IF 1.8 Q3 HEMATOLOGY

Hematology, Transfusion and Cell Therapy Pub Date : 2025-05-09 DOI:10.1016/j.htct.2025.103841

Zahia Esber, Hamza Salam, Shefali Godara, Ayman Soubani

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引用次数: 0

摘要

非结核性分枝杆菌感染是骨髓移植的并发症，肺部疾病是最常见的临床表现。在造血干细胞移植患者中，这些感染的识别和管理仍未得到充分认识。本研究旨在探讨移植后肺部感染患者的临床特点和预后。方法回顾了底特律三级癌症中心Karmanos癌症研究所11年来接受移植的3000名成年患者的图表。根据美国胸科学会（ATS）和美国疾病控制与预防中心指南，将51例移植后肺部非结核性分枝杆菌感染的诊断定义为明确、可能或可能。鉴定的微生物进一步被表征为快速或缓慢生长的分枝杆菌。收集和分析患者的临床特征、危险因素、微生物学数据、治疗方法和结局。结果约一半(n = 26；51%)的患者被确定为肺部感染。这些患者有心血管和肺部合并症的趋势。大多数(n = 44；86.3%)在移植物抗宿主病的情况下接受类固醇和免疫抑制治疗。最常见的症状是咳嗽的变化和呼吸急促的恶化。15例（29.4%）患者最常见的影像学表现为结节性浸润。38例（74.5%）患者检出鸟分枝杆菌复合体。这些感染的大多数患者（76.5%）没有接受抗真菌治疗。42例（82.4%）患者报告生存。结论不同分枝杆菌种类、定植率和免疫抑制程度对非结核性肺分枝杆菌感染的预后有显著影响。由于分枝杆菌生长缓慢，预后总体良好。需要前瞻性多中心研究来进一步指导这些患者的管理。

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Clinical characteristics and outcomes of non-tuberculous mycobacterial pulmonary infections after hematopoietic stem cell transplantation: A retrospective cohort study

Introduction

Non-tuberculous mycobacterial infections are rising as complications of bone marrow transplantation with lung disease being the most common clinical presentation. The identification and management of these infections in hematopoietic stem cell transplantation patients remains underrecognized. This study aims to investigate the clinical characteristics and outcomes in patients with post-transplant pulmonary infections.

Methods

The charts of 3,000 adult patients who received transplants over 11 years at the Karmanos Cancer Institute, a tertiary-care cancer center in Detroit, were reviewed. The diagnoses of post-transplant pulmonary non-tuberculous mycobacterial infections of 51 patients were defined as definite, probable or possible based on the American Thoracic Society (ATS) and Centers for Disease Control and Prevention guidelines. The identified organisms were further characterized as rapid- or slow-growing mycobacteria. Clinical characteristics, risk factors, microbiologic data, therapy and outcomes of the patients were collected and analyzed.

Results

About half (n = 26; 51%) of the patients were identified with definite pulmonary infection. There was a trend of cardiovascular and pulmonary comorbidities in these patients. The majority (n = 44; 86.3%) were on steroid and immunosuppressive therapy in the setting of graft-versus-host disease. The most common presenting symptoms were a combination of change in cough and worsening shortness of breath. The most common radiologic pattern was nodular infiltrates in 15 (29.4%) patients. Mycobacterium avium complex was identified in 38 (74.5%) patients. The majority of patients with these infections (76.5%) did not receive antimycobacterial therapy. Survival was reported in 42 (82.4%) patients.

Conclusion

Outcomes vary significantly among non-tuberculous mycobacterial pulmonary infections based on mycobacterial species, rate of colonization and degree of immunosuppression. The prognosis is overall good due to slow growing mycobacteria. Prospective multicenter studies are required to further guide the management of these patients.

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