Relationship between treatment and prognosis in patients with late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation.

Le Qing Cao; Jing Rui Zhou; Yu Hong Chen; Huan Chen; Wei Han; Yao Chen; Yuan Yuan Zhang; Chen Hua Yan; Yi Fei Cheng; Xiao Dong MO; Hai Xia FU; Ting Ting Han; Meng LV; Jun Kong; Yu Qian Sun; Yu Wang; Lan Ping XU; Xiao Hui Zhang; Xiao Jun Huang

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Relationship between treatment and prognosis in patients with late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation.

Author: Le Qing CAO ^{1
,

2
,

3
,

4} ; Jing Rui ZHOU ^{1
,

2
,

3
,

4} ; Yu Hong CHEN ^{1
,

2
,

3
,

4} ; Huan CHEN ^{1
,

2
,

3
,

4} ; Wei HAN ^{1
,

2
,

3
,

4} ; Yao CHEN ^{1
,

2
,

3
,

4} ; Yuan Yuan ZHANG ^{1
,

2
,

3
,

4} ; Chen Hua YAN ^{1
,

2
,

3
,

4} ; Yi Fei CHENG ^{1
,

2
,

3
,

4} ; Xiao Dong MO ^{1
,

2
,

3
,

4} ; Hai Xia FU ^{1
,

2
,

3
,

4} ; Ting Ting HAN ^{1
,

2
,

3
,

4} ; Meng LV ^{1
,

2
,

3
,

4} ; Jun KONG ^{1
,

2
,

3
,

4} ; Yu Qian SUN ^{1
,

2
,

3
,

4} ; Yu WANG ^{1
,

2
,

3
,

4} ; Lan Ping XU ^{1
,

2
,

3
,

4} ; Xiao Hui ZHANG ^{1
,

2
,

3
,

4} ; Xiao Jun HUANG ^{1
,

2
,

3
,

4}
Author Information

1. Department of Hematology, Peking University People's Hospital
2. Peking University Institute of Hematology
3. National Clinical Research Center for Hematologic Disease
4. Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China.
Publication Type:Journal Article
Keywords: Allogeneic hematopoietic stem cell transplantation; Antiviral agents; Glucocorticoids; Pneumonia; Prognosis
MeSH: Antiviral Agents/therapeutic use*; Glucocorticoids/therapeutic use*; Hematopoietic Stem Cell Transplantation/methods*; Humans; Pneumonia/etiology*; Prognosis; Retrospective Studies; Transplantation, Homologous/adverse effects*
From: Journal of Peking University(Health Sciences) 2022;54(5):1013-1020
CountryChina
Language:Chinese
Abstract: OBJECTIVE:To explore the relationship between drug treatment and outcomes in patients with late-onset severe pneumonia (LOSP) after allogeneic stem cell transplantation (allo-SCT).
METHODS:We retrospectively analyzed the effects of the initiation time of treatment drugs, especially antiviral drugs and glucocorticoids on the clinical outcomes in 82 patients between January 2016 and August 2021 who developed LOSP after allo-SCT in Peking University People's Hospital. Univariate analysis was performed by Mann-Whitney U test and χ² test, and multivariate analysis was performed by Logistic regression. When multiple groups (n>2) were involved in the χ² test, Bonferroni correction was used for the level of significance test.
RESULTS:Of all 82 patients in this study, the median onset time of LOSP was 220 d (93-813 d) after transplantation, and the 60-day survival rate was 58.5% (48/82). The median improvement time of the survival patients was 18 d (7-44 d), while the median death time of the died patients was 22 d (2-53 d). Multivariate analysis showed that the initiation time of antiviral drugs from the onset of LOSP (< 10 d vs. ≥10 d, P=0.012), and the initiation time of glucocorticoids from antiviral drugs (< 10 d vs. ≥10 d, P=0.027) were the factors affecting the final outcome of the patients with LOSP at the end of 60 d. According to the above results, LOSP patients were divided into four subgroups: group A (antiviral drugs < 10 d, glucocorticoids ≥10 d), group B (antiviral drugs < 10 d, glucocorticoids < 10 d), group C (antiviral drugs ≥10 d, glucocorticoids ≥10 d) and group D (antiviral drugs ≥10 d, glucocorticoids < 10 d), the 60-day survival rates were 91.7%, 56.8%, 50.0% and 21.4%, respectively.
CONCLUSION:Our study demonstrated that in patients who developed LOSP after allo-SCT, the initiation time of antiviral drugs and glucocorticoids were associated with the prognosis of LOSP, and the survival rate was highest in patients who received antiviral drugs early and glucocorticoids later. It suggested that for patients with LOSP of unknown etiology should be highly suspicious of the possibility of a secondary hyperimmune response to viral infection.