Pulmonary Complications in Pediatric and Adolescent Patients Following Allogeneic Hematopoietic Cell Transplantation

Larisa Broglie, Caitrin Fretham, Amal Al-Seraihy, Biju George, Joanne Kurtzberg, Alison Loren, Margaret MacMillan, Caridad Martinez, Stella M. Davies, Marcelo C. Pasquini

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Pulmonary complications after hematopoietic cell transplantation (HCT) can lead to significant morbidity and mortality. Limited evaluation of the true incidence of these complications in children and subsequent outcomes of these complications have not been evaluated recently. In April 2018, the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and the National Cancer Institute cosponsored a meeting of experts to describe the status of pulmonary complications in children after HCT, identify critical gaps in knowledge, and explore avenues for research to advance care and optimize outcomes. The Center for International Blood and Marrow Transplant Research was used to evaluate the cumulative incidence of pulmonary complications in children and their respective survival. Of the 5022 children included in this analysis who received allogeneic HCT from 2010 to 2016, 606 developed pulmonary complications within the first year after HCT. Pneumonitis occurred in 388 patients, 125 patients developed pulmonary hemorrhage, and 200 patients had lung graft-versus-host disease (GVHD). For those developing pulmonary complications within 1 year, overall survival 100 days after diagnosis of pulmonary complications was 49% (95% confidence interval [CI], 43% to 54%) for patients with pneumonitis, 23% (95% CI, 16% to 31%) in patients with pulmonary hemorrhage, and 87% (95% CI, 81% to 91%) in patients with pulmonary GVHD. This study demonstrates the approximate incidence of these complications, as well as their significant effects on survival, and can serve as a baseline for future research.

Original languageEnglish (US)
Pages (from-to)2024-2030
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number10
DOIs
StatePublished - Oct 2019

Bibliographical note

Funding Information:
The data were prepared and presented at the Workshop on Pulmonary Complications of Pediatric Hematopoietic Stem Cell Transplantation that was cosponsored by the NHLBI, NICHD, and NCI and organized by Kenneth R. Cooke, MD, Samuel B. Goldfarb, MD, Ashok Srinivasan, MD, James S. Hagood, MD, and Dennis C. Stokes, MD, MPH. We also acknowledge the support of the lead program directors from the NHLBI, NICHD, and NCI, particularly Aruna Natarajan, MD, PhD, and Robert Tamburro, MD, MSc.

Funding Information:
The data were prepared and presented at the Workshop on Pulmonary Complications of Pediatric Hematopoietic Stem Cell Transplantation that was cosponsored by the NHLBI, NICHD, and NCI and organized by Kenneth R. Cooke, MD, Samuel B. Goldfarb, MD, Ashok Srinivasan, MD, James S. Hagood, MD, and Dennis C. Stokes, MD, MPH. We also acknowledge the support of the lead program directors from the NHLBI, NICHD, and NCI, particularly Aruna Natarajan, MD, PhD, and Robert Tamburro, MD, MSc. Financial disclosure:The CIBMTR is supported primarily by Public Health Service grant/cooperative agreement 5U24CA076518 from the NCI, NHLBI, and the National Institute of Allergy and Infectious Diseases (NIAID); grant/cooperative agreement 1U24HL138660 from the NHLBI and NCI; contract HHSH250201700006C with the Health Resources and Services Administration (HRSA/DHHS); grants N00014?17?1?2388, N00014?17?1?2850, and N00014?18?1?2045 from the Office of Naval Research HHSH250201700006C; and grants from Adaptive Biotechnologies; *Amgen, Inc; anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; Atara Biotherapeutics, Inc; Be the Match Foundation; *bluebird bio, Inc; *Bristol Myers Squibb Oncology; *Celgene Corporation; *Chimerix, Inc; *CytoSen Therapeutics, Inc; Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Gilead Sciences, Inc; HistoGenetics, Inc; Immucor; *Incyte Corporation; Janssen Scientific Affairs, LLC; *Jazz Pharmaceuticals, Inc; Karius, Inc; Karyopharm Therapeutics, Inc; *Kite Pharma, Inc; Medac, GmbH; *Mediware; The Medical College of Wisconsin; *Merck & Co, Inc; *Mesoblast; MesoScale Diagnostics, Inc; Millennium, the Takeda Oncology Co.; *Miltenyi Biotec, Inc; Mundipharma EDO; National Marrow Donor Program; Novartis Pharmaceuticals Corporation; PCORI; *Pfizer, Inc; *Pharmacyclics, LLC; PIRCHE AG; *Sanofi Genzyme; *Seattle Genetics; Shire; Spectrum Pharmaceuticals, Inc; St. Baldrick's Foundation; Swedish Orphan Biovitrum, Inc; *Takeda Oncology; and University of Minnesota. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US government. *Corporate members. Conflict of interest statement: There are no conflicts of interest to report.

Funding Information:
Financial disclosure: The CIBMTR is supported primarily by Public Health Service grant/cooperative agreement 5U24CA076518 from the NCI, NHLBI, and the National Institute of Allergy and Infectious Diseases (NIAID); grant/cooperative agreement 1U24HL138660 from the NHLBI and NCI; contract HHSH250201700006C with the Health Resources and Services Administration (HRSA/DHHS); grants N00014‐17‐1‐2388, N00014‐17‐1‐2850, and N00014‐18‐1‐2045 from the Office of Naval Research HHSH250201700006C; and grants from Adaptive Biotechnologies; *Amgen, Inc; anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; Atara Biotherapeutics, Inc; Be the Match Foundation; *bluebird bio, Inc; *Bristol Myers Squibb Oncology; *Celgene Corporation; *Chimerix, Inc; *CytoSen Therapeutics, Inc; Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Gilead Sciences, Inc; HistoGenetics, Inc; Immucor; *Incyte Corporation; Janssen Scientific Affairs, LLC; *Jazz Pharmaceuticals, Inc; Karius, Inc; Karyopharm Therapeutics, Inc; *Kite Pharma, Inc; Medac, GmbH; *Mediware; The Medical College of Wisconsin; *Merck & Co, Inc; *Mesoblast; MesoScale Diagnostics, Inc; Millennium, the Takeda Oncology Co.; *Miltenyi Biotec, Inc; Mundipharma EDO; National Marrow Donor Program; Novartis Pharmaceuticals Corporation; PCORI; *Pfizer, Inc; *Pharmacyclics, LLC; PIRCHE AG; *Sanofi Genzyme; *Seattle Genetics; Shire; Spectrum Pharmaceuticals, Inc; St. Baldrick's Foundation; Swedish Orphan Biovitrum, Inc; *Takeda Oncology; and University of Minnesota. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US government.

Publisher Copyright:
© 2019 American Society for Transplantation and Cellular Therapy

Keywords

  • Lung GVHD
  • Pediatrics
  • Pneumonitis
  • Pulmonary hemorrhage

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