title: Lower leukemia relapse in pediatric patients with pulmonary cytolytic thrombi following allogeneic transplant.
abstract: Pulmonary cytolytic thrombi (PCT) is an uncommon complication after hematopoietic cell transplantation. Although the pathogenesis is unknown, patients typically respond to systemic corticosteroid treatment. Considering corticosteroids may impair GVL reactions, we reviewed the records of 324 pediatric patients who received a transplant for leukemia and compared the outcomes of those with PCT (n=14) to those without PCT (n=310). PCT patients had a significantly more acute GVHD (aGVHD) and chronic GVHD (cGVHD). Though 3-year non-relapse mortality and OS were similar, there was significantly less relapse in patients with PCT compared to those without PCT (0 vs 28%, P=0.02), regardless of the presence or absence of aGVHD. In multivariate analysis, grade II-IV aGVHD (P=0.02), cGVHD (P=0.01) and development of PCT (P<0.01) were independently associated with less relapse. These data suggest that patients with PCT are at greater risk for GVHD, but at lower risk of leukemia relapse.
authors.affiliation: Pediatric Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA. smith719@umn.edu
authors.forename: A R
authors.initials: AR
authors.lastname: Smith
authors.forename: E
authors.initials: E
authors.lastname: Gulbahce
authors.forename: M J
authors.initials: MJ
authors.lastname: Burke
authors.forename: Q
authors.initials: Q
authors.lastname: Cao
authors.forename: M L
authors.initials: ML
authors.lastname: Macmillan
authors.forename: J
authors.initials: J
authors.lastname: Tolar
authors.forename: P J
authors.initials: PJ
authors.lastname: Orchard
authors.forename: B R
authors.initials: BR
authors.lastname: Blazar
authors.forename: K S
authors.initials: KS
authors.lastname: Baker
authors.forename: J E
authors.initials: JE
authors.lastname: Wagner
authors.forename: M R
authors.initials: MR
authors.lastname: Verneris
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007938:Leukemia / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D011655:Pulmonary Embolism / Q000209:etiology* / Q000473:pathology; D012008:Recurrence; D019172:Transplantation Conditioning / Q000009:adverse effects*; D016896:Treatment Outcome