Risk factors for interstitial pneumonia following bone marrow transplantation for severe aplastic anaemia.
Data from 547 patients with aplastic anaemia who received bone marrow transplants from HLA-identical siblings were analysed to determine factors associated with the risk of interstitial pneumonia (IPn). IPn developed in 92 patients (17%). 37% of cases were associated with cytomegalovirus infection and 22% with other organisms; in 41% of cases no organism was identified. The case fatality rate was 64%; the mortality rate due to IPn was 11%. In multivariate analysis, four factors were associated with an increased probability of interstitial pneumonia: use of methotrexate rather than cyclosporine after transplantation (relative risk, 2.8; P less than 0.0008); occurrence of moderate to severe acute graft-versus-host disease (relative risk, 2.2; P less than 0.002); inclusion of total body radiation in the pretransplant preparative regimen (relative risk 2.2, P less than 0.004); and patient age greater than 20 (relative risk 1.7, P less than 0.002). The probability of IPn ranged from 4% for patients with none of these adverse risk factors to 51% (relative risk of 13.4) for patients with all four. The incidence of IPn decreased significantly between 1978 and 1985, paralleling a decrease in the use of total body radiation pretransplant for immune suppression and methotrexate post-transplant for prophylaxis against graft-versus-host disease.
Weiner
R S
RS
Department of Medicine, Medical College of Wisconsin, Milwaukee 53226.
Horowitz
M M
MM
Gale
R P
RP
Dicke
K A
KA
van Bekkum
D W
DW
Masaoka
T
T
Ramsay
N K
NK
Rimm
A A
AA
Rozman
C
C
Bortin
M M
MM
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011658:Pulmonary Fibrosis / Q000209:etiology* / Q000401:mortality; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors
D008727:Methotrexate