Hematopoetik Kök Hücre Transplantasyonu Yapılan Hastalarda Pulmoner Komplikasyonlar

Abstract

Hematopoietic stem cell transplantation (HSCT) is used as a therapeutic approach for many malignant or non-malignat diseases. Complications concerning various organs can be seen after HSCT. Pulmonary complications cause serious morbidity and mortality. Pulmonary complications are classified into two groups as early and late-onset according to their time of onset; or infectious and non-infectious according to existence of an infectious pathogen. Underlying primary disorder, having a previous lung disease, advanced age, allogeneic transplantation, chemotherapy, radiotherapy, neutropenia, graft versus host disease (GVHD) and use of immunosppressant therapy are some of the risk factors for pulmonary complications after HSCT. In this study, patients who received HSCT between January 2005 and December 2015 at Hacettepe University Ihsan Dogramaci Children’s Hospital Bone Marrow Transplantation Unit and developed pulmonary complications were included in the study. The patient files were analyzed retrospectively and the risk factors for pulmonary complications following HSCT were studied. Pulmonary complications developed in 71 (36,4 %) of 195 HSCT recipients following HSCT. When studied according to the primary diagnoses, most of the patients who developed pulmonary complication were in the malignancy group, whereas hemophagocytosis being the least. Of the 71 patients who had pulmonary complications following HSCT, 60 had one pulmonary complication, 11 had two pulmonary complications. Therefore pulmonary complications following HSCT were evaluated on those 82 episodes. 42 (51,2%) complications were early onset, 40 (48,8%) were late onset. 28 of the complications were infectious in origin, 20 were non-infectious and in 34 of the complications infectious and non-infectious causes were found to be together. When studied according to the patients’ neutropenia, GVHD, immunosuppressant therapy status in developing pulmonary complications after HSCT, in 71 of the 82 complication episodes the patients were receiving immunosuppressive therapy, 37 patients had neutropenia, 31 patients had GVHD (15 of them were acute GVHD, 16 were chronic). When patients who developed pulmonary complications after HSCT and the patients who had no pulmonary complications were compared according to their primary diagnoses, pulmonary complications developed significantly more frequently in the malignancy and congenital immune deficiency groups, whereas hemoglobinopathy and bone marrow deficiency groups developed significantly less pulmonary complications. Additionally, patients who had pulmonary complications significantly had at least one pulmonary disease before HSCT. Among patients who had pulmonary complications, the number of the patients who received myeloablative conditioning regimen was significantly higher than the patients who did not receive myeloablative conditioning regimen. In patients with osteopetrosis, early onset complications were more frequent. In the bone marrow deficiency group, infectious complications were more frequent, and in the neurometabolic disease group non-infectious complications developed more often. When pulmonary function tests were evaluated, there was no significant difference between the groups who had pulmonary complications and with no pulmonary complications in terms of spirometric lung function indices (FEV1, FVC, FEV1/FVC, FEF 25-75). When the pulmonary complication episodes following HSCT were analyzed, of the 82 complication episodes 54 recovered, 18 patients died, 4 episodes were lost to follow up, 6 episodes became chronic. The primary diagnoses of the the patients who died were mostly in malignancy group, and least in congenital immune deficiency and hemoglobinopathy groups. As a consequence in univariate analyses, underlying primary disorder, myeloablative conditioning regimen and previous lung disease were found to be the risk factors for pulmonary complications following HSCT but in multivariate analyses these alone were not statistically significant risk factors for pulmonary complications following HSCT by themselves. In addition, it was found that GVHD, neutropenia and immunosuppressive therapies accompanied pulmonary complications and that the time of onset of complication and infectious nature of the complication differed according to underlying primary disease.