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Early and late interstitial pneumonia following human bone marrow transplantation
Abstract:
Interstitial pneumonia is a major determinant of early and late morbidity and mortality following bone marrow transplantation. Among 952 patients receiving allogeneic marrow grafts in Seattle, 35% developed interstitial pneumonia within 100 days of transplant. Development of early cytomegalovirus (CMV) or idiopathic interstitial pneumonia was infrequent in patients with aplastic anemia prepared only with cyclophosphamide. Use of total body irradiation (TBI) in the transplant preparation, increasing patient age, pretransplant seropositivity for CMV antibody and post-transplant development of graft-versus-host disease (GVHD) all increased the risk of CMV pneumonia. Late interstitial pneumonia was studied in patients with chronic GVHD. Among 198 patients with extensive chronic GVHD, 31 episodes of interstitial pneumonia (seven idiopathic, six CMV, six pneumocystis, five miscellaneous and four unknown causes, and three varicella-zoster) were observed 3-24 months after transplant. In untreated patients with chronic GVHD, 15% developed late interstitial pneumonia. Patients with chronic GVHD who received prednisone +/- azathioprine as immunosuppressive therapy and trimethoprim sulfamethoxazole for infection prophylaxis had an 8% incidence of interstitial pneumonia. Patients with chronic GVHD given immunosuppressive treatment without trimethoprim sulfamethoxazole prophylaxis had a 28% incidence of interstitial pneumonia. Trimethoprim sulfamethoxazole significantly reduced the incidence of late interstitial pneumonia in patients with chronic GVHD (p = 0.001).
Insights
Interstitial pneumonia is a significant risk after bone marrow transplants. Prophylactic trimethoprim sulfamethoxazole significantly reduced late interstitial pneumonia in patients with chronic graft-versus-host disease.
Area of Science:
- Hematology
- Immunology
- Pulmonology
Background:
- Interstitial pneumonia is a critical factor influencing morbidity and mortality post-bone marrow transplantation.
- Approximately 35% of patients undergoing allogeneic marrow grafts develop interstitial pneumonia within 100 days.
Purpose of the Study:
- To investigate risk factors for early and late interstitial pneumonia following bone marrow transplantation.
- To evaluate the impact of prophylactic trimethoprim sulfamethoxazole on late interstitial pneumonia in patients with chronic graft-versus-host disease.
Main Methods:
- Retrospective analysis of 952 patients receiving allogeneic marrow grafts.
- Analysis of risk factors including total body irradiation (TBI), patient age, cytomegalovirus (CMV) seropositivity, and graft-versus-host disease (GVHD).
- Comparison of late interstitial pneumonia incidence in chronic GVHD patients with and without trimethoprim sulfamethoxazole prophylaxis.
Main Results:
- Early interstitial pneumonia risk factors included TBI, older age, CMV seropositivity, and post-transplant GVHD.
- In patients with extensive chronic GVHD, 15% developed late interstitial pneumonia without prophylaxis.
- Trimethoprim sulfamethoxazole prophylaxis reduced the incidence of late interstitial pneumonia in chronic GVHD patients from 28% to 8% (p = 0.001).
Conclusions:
- Early interstitial pneumonia is associated with specific transplant preparative regimens and patient factors.
- Prophylactic trimethoprim sulfamethoxazole significantly decreases the incidence of late interstitial pneumonia in bone marrow transplant recipients with chronic GVHD.