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Published on: September 6, 2017
Pleuroparenchymal fibroelastosis after hematopoietic stem cell transplantation in children: a propensity
Sae-Lin Oh1,2, Ji Won Lee3, So-Young Yoo1
1Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Insights
Pleuroparenchymal fibroelastosis (PPFE) affects 4% of pediatric stem cell transplant recipients, often leading to poor outcomes. Pneumonia post-transplant may increase the risk of developing PPFE.
Area of Science:
- Pediatric Hematology
- Pulmonary Medicine
- Transplant Medicine
Background:
- Pleuroparenchymal fibroelastosis (PPFE) is a rare lung disease.
- Its occurrence and impact in pediatric hematopoietic stem cell transplantation (HSCT) recipients are not well-defined.
- Understanding PPFE in this population is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of PPFE in pediatric HSCT recipients.
- To identify risk factors associated with PPFE development.
- To evaluate the clinical outcomes and survival rates of pediatric HSCT recipients with PPFE.
Main Methods:
- Retrospective, case-control study of 738 pediatric HSCT recipients.
- Chest CT scans analyzed for PPFE diagnosis.
- Propensity score-matched analysis to compare PPFE and control groups.
- Risk factors and outcomes analyzed using regression models and survival analysis.
Main Results:
- PPFE incidence was 4% in pediatric HSCT recipients.
- Pneumonia occurring more than 3 months post-HSCT was a significant risk factor (HR=10.78).
- The PPFE group had higher mortality (73%) and poorer survival (6.8 years) compared to controls.
Conclusions:
- PPFE is a severe complication following pediatric HSCT, representing a type of late-onset noninfectious pulmonary complication.
- Pneumonia after HSCT is a potential risk factor for PPFE development.
- PPFE is associated with significantly worse clinical outcomes and high mortality in this population.
Objectives:
To investigate the incidence, risk factors, and clinical outcomes of pleuroparenchymal fibroelastosis (PPFE) in pediatric hematopoietic stem cell transplantation (HSCT) recipients.
Methods:
This single-center, retrospective, case-control study included 738 consecutive patients who underwent chest CT more than 3 months after HSCT. We identified patients who fulfilled the diagnostic criteria for PPFE and assessed their clinical characteristics and radiologic findings. Propensity score-matched analysis was performed using four covariates (age, sex, HSCT type, and primary disease). The risk factors and clinical outcomes of PPFE were analyzed using the Fine and Gray regression model and stratified log-rank test in the matched groups.
Results:
PPFE was identified in 4% (31/738, 8.3 ± 3.1 years, 15 males) of the pediatric HSCT recipients with a median time of 2.7 years after HSCT, and it occurred following allogeneic (5%, 15/317), autologous (4%, 15/379), or both (2%, 1/42). Matching yielded 30 and 130 cases in the PPFE and control groups, respectively. The PPFE group showed more frequent late-onset noninfectious pulmonary complications (LONIPCs) and pneumonia more than 3 months after HSCT (p < 0.05). Multivariable analysis showed a significantly higher risk of PPFE in HSCT recipients who had pneumonia more than 3 months after HSCT (hazard ratio = 10.78 [95% confidence interval: 4.29, 27.13], p < 0.001). The PPFE group showed higher mortality (73%, 22/30) and poorer median overall survival (6.8 years [95% confidence interval: 4.1, 9.5]) than the control group (p < 0.001).
Conclusions:
PPFE represents a severe type of LONIPC after HSCT. HSCT recipients with pneumonia after HSCT may have an increased risk of PPFE.
Key Points:
• The incidence of pleuroparenchymal fibroelastosis is not negligible (4%), and it can occur after either allogeneic or autologous hematopoietic stem cell transplantation. • Pleuroparenchymal fibroelastosis after hematopoietic stem cell transplantation showed poor outcome with a high mortality rate of 73% and median overall survival of 6.8 years. • After hematopoietic stem cell transplantation, pneumonia may increase the risk of pleuroparenchymal fibroelastosis development in children. • Lung biopsy should not be indicated in patients with pleuroparenchymal fibroelastosis findings on chest CT as it can cause refractory pneumothorax without helping the diagnosis.
