Pre-transplant risk factors for cryptogenic organizing pneumonia/bronchiolitis obliterans organizing pneumonia after hematopoietic cell transplantation.
Cryptogenic organizing pneumonia (COP), previously known as bronchiolitis obliterans organizing pneumonia (BOOP), is a significant complication after allogeneic hematopoietic SCT (HCT). However, the pathogenesis of this complication has not yet been elucidated. Therefore, we identified the pre-transplant risk factors for the development of COP/BOOP using the Japan transplant registry database between 2005 and 2009. Among 9550 eligible recipients, 193 experienced COP/BOOP (2%). HLA disparity (odds ratio (OR) 1.51, P=0.05), female-to-male HCT (OR 1.53, P=0.023), and PBSC transplant (OR 1.84, P=0.0076) were significantly associated with an increased risk of COP/BOOP. On the other hand, BU-based myeloablative conditioning (OR 0.52, P=0.033), or fludarabine-based reduced-intensity conditioning (OR 0.50, P=0.0011) in comparison with a TBI-based regimen and in vivo T-cell depletion (OR 0.46, P=0.055) were associated with a lower risk. Of the 193 patients with COP/BOOP, 77 died, including non-relapse death in 46 (59%). Pulmonary failure and fatal infection accounted for 41% (n=19) and 26% (n=12) of the non-relapse death. Allogeneic immunity and conditioning toxicity could be associated with COP/BOOP. Prospective studies are required to elucidate the true risk factors for COP/BOOP and to develop a prophylactic approach.
1] Division of Bone and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA, USA [2] Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
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H
Nakasone
M
M
Onizuka
N
N
Suzuki
N
N
Fujii
S
S
Taniguchi
K
K
Kakihana
H
H
Ogawa
K
K
Miyamura
T
T
Eto
H
H
Sakamaki
H
H
Yabe
Y
Y
Morishima
K
K
Kato
R
R
Suzuki
T
T
Fukuda
D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018549:Cryptogenic Organizing Pneumonia / Q000209:etiology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult