title: Incidence, etiology, and outcome of pleural effusions in allogeneic hematopoietic stem cell transplantation.
abstract: Pleural effusion is a known entity in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT); however, the incidence, risk factors, and morbidity-mortality outcomes associated with pleural effusions remain unknown. We retrospectively evaluated pleural effusions in 618 consecutive adult patients who underwent allogeneic HSCT from January 2008 to December 2013 at our institution. Seventy one patients developed pleural effusion at a median of 40 days (range, 1 - 869) post-HSCT with the cumulative incidence of 9.9% (95% CI, 7.7 - 12.5%) at 1 year. Infectious etiology was commonly associated with pleural effusions followed by volume overload and serositis type chronic GVHD. In multivariate analysis, higher comorbidity index (P = 0.03) and active GVHD (P = 0.018) were found to be significant independent predictors for pleural effusion development. Higher comorbidity index, very high disease risk index, ≤7/8 HLA matching, and unrelated donor were associated with inferior overall survival (OS) (P < 0.03). More importantly, patients with pleural effusion were noted to have poor OS in comparison to patients without pleural effusion (P < 0.001). Overall, pleural effusion is a frequently occurring complication after allogeneic HSCT, adding to morbidity and mortality and hence, early identification is required. Am. J. Hematol. 91:E341-E347, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan.
authors.forename: Dipenkumar
authors.initials: D
authors.lastname: Modi
authors.affiliation: Department of Oncology, Biostatistics Core, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Hyejeong
authors.initials: H
authors.lastname: Jang
authors.affiliation: Department of Oncology, Biostatistics Core, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Seongho
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, Detroit, Michigan.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Deol
authors.affiliation: Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, Michigan.
authors.forename: Lois
authors.initials: L
authors.lastname: Ayash
authors.affiliation: Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, Michigan.
authors.forename: Divaya
authors.initials: D
authors.lastname: Bhutani
authors.affiliation: Division of Hematology/Oncology, Director of Cellular Therapy, Scientific Director of BMT, University of Virginia Cancer Center, Michigan.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lum
authors.affiliation: Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, Detroit, Michigan.
authors.forename: Voravit
authors.initials: V
authors.lastname: Ratanatharathorn
authors.affiliation: Department of Oncology, Clinical Trials Office Bone Marrow Transplant, Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Richard
authors.initials: R
authors.lastname: Manasa
authors.affiliation: Department of Oncology, Clinical Trials Office Bone Marrow Transplant, Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Kendra
authors.initials: K
authors.lastname: Mellert
authors.affiliation: Department of Oncology, Co-Director, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, Detroit, Michigan.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Uberti
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult