title: Incidence, risk factors, and mortality from pneumonia developing late after hematopoietic stem cell transplantation.
abstract: The incidence, etiology, outcome, and risk factors for developing pneumonia late after hematopoietic stem cell transplantation (SCT) were investigated in 1359 patients transplanted in Seattle. A total of 341 patients (25% of the cohort) developed at least one pneumonic episode. No microbial or tissue diagnosis (ie clinical pneumonia) was established in 197 patients (58% of first pneumonia cases). Among the remaining 144 patients, established etiologies included 33 viral (10%), 31 bacterial (9%), 25 idiopathic pneumonia syndrome (IPS, 7%), 20 multiple organisms (6%), 19 fungal (6%), and 16 Pneumocystis carinii pneumonia (PCP) (5%). The overall cumulative incidence of first pneumonia at 4 years after discharge home was 31%. The cumulative incidences of pneumonia according to donor type at 1 and 4 years after discharge home were 13 and 18% (autologous/syngeneic), 22 and 34% (HLA-matched related), and 26 and 39% (mismatched related/unrelated), respectively. Multivariate analysis of factors associated with development of late pneumonia after allografting were increasing patient age (RR 0.5 for <20 years, 1.2 for >40 years, P=0.009), donor HLA-mismatch (RR 1.6 for unrelated/mismatched related, P=0.01), and chronic graft-versus-host disease (GVHD; RR 1.5, P=0.007). Our data suggest that extension of PCP prophylaxis may be beneficial in high-risk autograft recipients. Further study of long-term anti-infective prophylaxis based on patient risk factors after SCT appear warranted.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center and the University of Washington, School of Medicine Seattle, WA, USA.
authors.forename: Chien-Shing
authors.initials: CS
authors.lastname: Chen
authors.forename: M
authors.initials: M
authors.lastname: Boeckh
authors.forename: K
authors.initials: K
authors.lastname: Seidel
authors.forename: J G
authors.initials: JG
authors.lastname: Clark
authors.forename: E
authors.initials: E
authors.lastname: Kansu
authors.forename: D K
authors.initials: DK
authors.lastname: Madtes
authors.forename: J L
authors.initials: JL
authors.lastname: Wagner
authors.forename: R P
authors.initials: RP
authors.lastname: Witherspoon
authors.forename: C
authors.initials: C
authors.lastname: Anasetti
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: W I
authors.initials: WI
authors.lastname: Bensinger
authors.forename: H J
authors.initials: HJ
authors.lastname: Deeg
authors.forename: P J
authors.initials: PJ
authors.lastname: Martin
authors.forename: J E
authors.initials: JE
authors.lastname: Sanders
authors.forename: R
authors.initials: R
authors.lastname: Storb
authors.forename: J
authors.initials: J
authors.lastname: Storek
authors.forename: J
authors.initials: J
authors.lastname: Wade
authors.forename: M
authors.initials: M
authors.lastname: Siadak
authors.forename: M E D
authors.initials: ME
authors.lastname: Flowers
authors.forename: K M
authors.initials: KM
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006648:Histocompatibility; D006801:Humans; D015994:Incidence; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D016720:Pneumocystis Infections / Q000209:etiology; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome