Early pulmonary complications after hematopoietic stem cell transplantation in pediatric patients: association with cytomegalovirus infection.
Pulmonary complications resulting in high morbidity and mortality occur in a substantial proportion of hematopoietic stem cell transplantation (HSCT) recipients. We investigated the incidence, causes, and risk factors of pulmonary complications, early after HSCT in pediatric patients, and patient outcomes by retrospective analysis of patients who underwent HSCT at Seoul National University Children's Hospital between September 2003 and June 2007. A total of 145 patients were evaluated of whom 15 (10.3%) developed pulmonary complications. Eight patients were suspected to have infection-related pulmonary complications and 7 had noninfectious causes. In a multivariate analysis of allogeneic transplantation recipients, detection of cytomegalovirus antigenemia was significantly associated with the development of both pulmonary complications and acute respiratory distress syndrome. Eleven (73.3%) of the 15 patients developed acute respiratory distress syndrome, required mechanical ventilation and eventually died. Early use of methylprednisolone in 3 patients decreased the oxygenation index. Sixteen patients died due to treatment-related complications early after HSCT, and pulmonary complications accounted for a substantial portion of the mortality. Thus, improvement of prophylaxis and management for pulmonary complications is crucial to improve the overall outcome of HSCT. More aggressive prophylaxis and treatment of cytomegalovirus infection and judicious use of methylprednisolone at the appropriate time could be the means for such improvement.
Lee
Ji Won
JW
Division of Hematology/Oncology, Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Jongno-Gu, Seoul, Republic of Korea.
Kang
Hyoung Jin
HJ
Park
June Dong
JD
Shin
Hee Young
HY
Ahn
Hyo Seop
HS
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000956:Antigens, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009369:Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000628:therapy / Q000821:virology; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D000893:Anti-Inflammatory Agents; D000956:Antigens, Viral; D008775:Methylprednisolone