title: High-dose cyclophosphamide therapy associated with diffuse alveolar hemorrhage after allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  The occurrence of diffuse alveolar hemorrhage (DAH) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare but severe. There are few reports that have examined the correlation between pre-HSCT chemotherapeutic exposure and DAH.
  
  
  OBJECTIVE
  We examine the role of pre-HSCT chemotherapeutic exposure, conditioning regimens, pre-HSCT comorbidities and transplant-related complications in the development of DAH after allo-HSCT and evaluate the effect of the high-dose corticosteroid strategy on DAH.
  
  
  METHODS
  A retrospective nested case-control study was designed. Cases with DAH and controls matched for year of allo-HSCT and length of follow-up were identified from a cohort of 597 patients who underwent allo-HSCT between 2006 and 2011 for acute leukemia.
  
  
  RESULTS
  Twenty-two patients suffered from DAH; the mean age at the time of presentation was 30.4 years (±12.9) and the mean time to presentation was 7.8 months (±8.1) post-HSCT. The pre-HSCT cyclophosphamide exposure and the cumulative cyclophosphamide dose were significantly higher among the DAH cases compared with the controls, and the cumulative cyclophosphamide dose of ≥5 g/m(2) was independently associated with DAH (OR = 3.4, p = 0.030). High-dose corticosteroid treatment did not significantly improve survival.
  
  
  CONCLUSIONS
  From these results we can identify patients who are at a higher risk of developing DAH after allo-HSCT, and we found that high-dose corticosteroid therapy may not alter the poor outcome associated with this syndrome.
authors.affiliation: Beijing Key Laboratory of Hematopoitic Stem Cell Transplantation, Peking University People's Hospital and Institute of Hematology, Beijing, PR China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Mo
authors.forename: Lan-Ping
authors.initials: LP
authors.lastname: Xu
authors.forename: Dai-Hong
authors.initials: DH
authors.lastname: Liu
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Zhang
authors.forename: Huan
authors.initials: H
authors.lastname: Chen
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Feng-Rong
authors.initials: FR
authors.lastname: Wang
authors.forename: Jing-Zhi
authors.initials: JZ
authors.lastname: Wang
authors.forename: Kai-Yan
authors.initials: KY
authors.lastname: Liu
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008171:Lung Diseases / Q000209:etiology* / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D011292:Premedication; D011650:Pulmonary Alveoli; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous
chemical_list: D018906:Antineoplastic Agents, Alkylating; D005938:Glucocorticoids; D003520:Cyclophosphamide