Incidence and outcome of idiopathic pneumonia syndrome in pediatric stem cell transplant recipients

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ABSTRACT Idiopathic pneumonia syndrome (IPS) is a rare complication following stem cell transplant (SCT) and its incidence among pediatric SCT recipients is not known. To assess the


incidence of IPS, we retrospectively reviewed the incidence of IPS at our center. IPS is defined as the presence of multilobar infiltrates by chest radiograph or computed tomography scan,


need for supplemental oxygenation with declining pulse oximetry and no identifiable pulmonary infection. Between July 1999 and August 2005, 11 of 93 children who received a fully ablative


allogeneic SCT (11.8%) developed IPS. All 11 patients had normal pulmonary evaluation before transplant. IPS developed at a median of 17 days (range 8–42 days) after transplant. Recipients


of unrelated donor transplant had increased risk of developing IPS. There was a significant association between acute or hyperacute graft-versus-host disease (GVHD) and IPS (_P_=0.035). All


patients had significant hypoxia and five patients required assisted ventilation. IPS was the cause of death in two patients. Although there was complete resolution of respiratory symptoms


in the other nine patients, overall transplant-related mortality was significantly higher among patients with IPS (64 vs 17%, _P_=0.002). IPS is a relatively common complication in pediatric


SCT recipients and acute GVHD is an important associated factor. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution


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about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS LATE-ONSET PULMONARY COMPLICATIONS FOLLOWING ALLOGENEIC HEMATOPOIETIC CELL


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PATIENTS UNDERGOING AUTOLOGOUS STEM CELL TRANSPLANTATION Article 04 December 2020 REFERENCES * Geller RB, Vogelsang GB, Wingard JR, Yeager AM, Burns WH, Santos GW _et al_. Successful marrow


transplantation for acute myelocytic leukemia following therapy for Hodgkin's disease. _J Clin Oncol_ 1988; 6: 1558–1561. Article  CAS  PubMed  Google Scholar  * Weiner RS, Dicke KA .


Risk factors for interstitial pneumonitis following allogeneic bone marrow transplantation for severe aplastic anemia: a preliminary report. _Transplant Proc_ 1987; 19 (Part 3): 2639–2642.


CAS  PubMed  Google Scholar  * Kantrow SP, Hackman RC, Boeckh M, Myerson D, Crawford SW . Idiopathic pneumonia syndrome: changing spectrum of lung injury after marrow transplantation.


_Transplantation_ 1997; 63: 1079–1086. Article  CAS  PubMed  Google Scholar  * Crawford SW, Hackman RC . Clinical course of idiopathic pneumonia after bone marrow transplantation. _Am Rev


Respir Dis_ 1993; 147 (Part 1): 1393–1400. Article  CAS  PubMed  Google Scholar  * Afessa B, Litzow MR, Tefferi A . Bronchiolitis obliterans and other late onset non-infectious pulmonary


complications in hematopoietic stem cell transplantation. _Bone Marrow Transplant_ 2001; 28: 425–434. Article  CAS  PubMed  Google Scholar  * Shankar G, Cohen DA . Idiopathic pneumonia


syndrome after bone marrow transplantation: the role of pre-transplant radiation conditioning and local cytokine dysregulation in promoting lung inflammation and fibrosis. _Int J Exp Pathol_


2001; 82: 101–113. Article  CAS  PubMed  PubMed Central  Google Scholar  * Della Volpe A, Ferreri AJ, Annaloro C, Mangili P, Rosso A, Calandrino R _et al_. Lethal pulmonary complications


significantly correlate with individually assessed mean lung dose in patients with hematologic malignancies treated with total body irradiation. _Int J Radiat Oncol Biol Phys_ 2002; 52:


483–488. Article  PubMed  Google Scholar  * Clark JG, Hansen JA, Hertz MI, Parkman R, Jensen L, Peavy HH . NHLBI workshop summary. Idiopathic pneumonia syndrome after bone marrow


transplantation. _Am Rev Respir Dis_ 1993; 147 (Part 1): 1601–1606. Article  CAS  PubMed  Google Scholar  * Pecego R, Hill R, Appelbaum FR, Amos D, Buckner CD, Fefer A _et al_. Interstitial


pneumonitis following autologous bone marrow transplantation. _Transplantation_ 1986; 42: 515–517. Article  CAS  PubMed  Google Scholar  * Granena A, Carreras E, Rozman C, Salgado C, Sierra


J, Algara M _et al_. Interstitial pneumonitis after BMT: 15 years experience in a single institution. _Bone Marrow Transplant_ 1993; 11: 453–458. CAS  PubMed  Google Scholar  * Meyers JD,


Flournoy N, Thomas ED . Nonbacterial pneumonia after allogeneic marrow transplantation: a review of ten years' experience. _Rev Infect Dis_ 1982; 4: 1119–1132. Article  CAS  PubMed 


Google Scholar  * Wingard JR, Mellits ED, Sostrin MB, Chen DY, Burns WH, Santos GW _et al_. Interstitial pneumonitis after allogeneic bone marrow transplantation. Nine-year experience at a


single institution. _Medicine (Baltimore)_ 1988; 67: 175–186. Article  CAS  Google Scholar  * Fukuda T, Hackman RC, Guthrie KA, Sandmaier BM, Boeckh M, Maris MB _et al_. Risks and outcomes


of idiopathic pneumonia syndrome after nonmyeloablative and conventional conditioning regimens for allogeneic hematopoietic stem cell transplantation. _Blood_ 2003; 102: 2777–2785. Article 


PubMed  Google Scholar  * Yanik G, Hellerstedt B, Custer J, Hutchinson R, Kwon D, Ferrara JL _et al_. Etanercept (Enbrel) administration for idiopathic pneumonia syndrome after allogeneic


hematopoietic stem cell transplantation. _Biol Blood Marrow Transplant_ 2002; 8: 395–400. Article  CAS  PubMed  Google Scholar  * Clark JG, Madtes DK, Martin TR, Hackman RC, Farrand AL,


Crawford SW . Idiopathic pneumonia after bone marrow transplantation: cytokine activation and lipopolysaccharide amplification in the bronchoalveolar compartment. _Crit Care Med_ 1999; 27:


1800–1806. Article  CAS  PubMed  Google Scholar  * Weiner RS, Bortin MM, Gale RP, Gluckman E, Kay HE, Kolb HJ _et al_. Interstitial pneumonitis after bone marrow transplantation. Assessment


of risk factors. _Ann Intern Med_ 1986; 104: 168–175. Article  CAS  PubMed  Google Scholar  * Crawford SW, Longton G, Storb R . Acute graft-versus-host disease and the risks for idiopathic


pneumonia after marrow transplantation for severe aplastic anemia. _Bone Marrow Transplant_ 1993; 12: 225–231. CAS  PubMed  Google Scholar  * Atkinson K, Nivison-Smith I, Dodds A, Concannon


A, Milliken S, Downs K . A comparison of the pattern of interstitial pneumonitis following allogeneic bone marrow transplantation before and after the introduction of prophylactic


ganciclovir therapy in 1989. _Bone Marrow Transplant_ 1998; 21: 691–695. Article  CAS  PubMed  Google Scholar  * Griese M, Rampf U, Hofmann D, Fuhrer M, Reinhardt D, Bender-Gotze C .


Pulmonary complications after bone marrow transplantation in children: twenty-four years of experience in a single pediatric center. _Pediatr Pulmonol_ 2000; 30: 393–401. Article  CAS 


PubMed  Google Scholar  * Atkinson K, Turner J, Biggs JC, Dodds A, Concannon A . An acute pulmonary syndrome possibly representing acute graft-versus-host disease involving the lung


interstitium. _Bone Marrow Transplant_ 1991; 8: 231–234. CAS  PubMed  Google Scholar  * Down JD, Mauch P, Warhol M, Neben S, Ferrara JL . The effect of donor T lymphocytes and total-body


irradiation on hemopoietic engraftment and pulmonary toxicity following experimental allogeneic bone marrow transplantation. _Transplantation_ 1992; 54: 802–808. Article  CAS  PubMed  Google


Scholar  * Cooke KR, Kobzik L, Martin TR, Brewer J, Delmonte Jr J, Crawford JM _et al_. An experimental model of idiopathic pneumonia syndrome after bone marrow transplantation: I. The


roles of minor H antigens and endotoxin. _Blood_ 1996; 88: 3230–3239. CAS  PubMed  Google Scholar  * Cooke KR, Hill GR, Gerbitz A, Kobzik L, Martin TR, Crawford JM _et al_. Tumor necrosis


factor-alpha neutralization reduces lung injury after experimental allogeneic bone marrow transplantation. _Transplantation_ 2000; 70: 272–279. Article  CAS  PubMed  Google Scholar  * Cooke


KR, Yanik G . Acute lung injury after allogeneic stem cell transplantation: is the lung a target of acute graft-versus-host disease? _Bone Marrow Transplant_ 2004; 34: 753–765. Article  CAS


  PubMed  Google Scholar  * Cooke KR . Acute lung injury after allogeneic stem cell transplantation: from the clinic, to the bench and back again. _Pediatr Transplant_ 2005; 9 (Suppl 7):


25–36. Article  PubMed  Google Scholar  * Yanik G, Cooke KR . The lung as a target organ of graft-versus-host disease. _Semin Hematol_ 2006; 43: 42–52. Article  PubMed  Google Scholar  *


Yanik GA, Levine JE, Ferrara JLM, Uberti JP, Ho VT, Antin JH _et al_. Survival following etanercept therapy for the treatment of Idiopathic pneumonia syndrome post allogeneic stem cell


transplantation. _Blood_ 2004; 104: 104A–105A. Google Scholar  Download references ACKNOWLEDGEMENTS We gratefully acknowledge the excellent care provided by the nursing and support staff.


AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Pediatric Stem Cell Transplant Program, Vanderbilt Children's Hospital, Vanderbilt University, Nashville, TN, USA J Keates-Baleeiro, B


Manes, C Calder & H Frangoul * Department of Pediatric Pulmonary, Vanderbilt University, Nashville, TN, USA P Moore * Department of Biostatistics, Vanderbilt University, Nashville, TN,


USA T Koyama Authors * J Keates-Baleeiro View author publications You can also search for this author inPubMed Google Scholar * P Moore View author publications You can also search for this


author inPubMed Google Scholar * T Koyama View author publications You can also search for this author inPubMed Google Scholar * B Manes View author publications You can also search for this


author inPubMed Google Scholar * C Calder View author publications You can also search for this author inPubMed Google Scholar * H Frangoul View author publications You can also search for


this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to H Frangoul. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Keates-Baleeiro,


J., Moore, P., Koyama, T. _et al._ Incidence and outcome of idiopathic pneumonia syndrome in pediatric stem cell transplant recipients. _Bone Marrow Transplant_ 38, 285–289 (2006).


https://doi.org/10.1038/sj.bmt.1705436 Download citation * Received: 11 April 2006 * Revised: 02 May 2006 * Accepted: 04 June 2006 * Published: 03 July 2006 * Issue Date: 01 August 2006 *


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currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative KEYWORDS * idiopathic * pneumonia * transplant * children