Pulmonary Complications Following Hematopoietic Stem Cell Transplantation

Introduction Hematopoietic stem cell transplantation (HSCT) has been established as a therapeutic option for a wide variety of malignant and non-malignant pathologies. However, the outcome of HSCT is limited by several side effects, among which pulmonary toxicity stands out, with pulmonary complications that may be early or late and infectious or non-infectious. Given the morbidity and mortality associated with these events, the aim of the present study is to assess the prevalence of pulmonary complications in patients who underwent HSCT in a Colombian population. Methods An observational descriptive, ambispective study was conducted at a tertiary referral center in Colombia, South America, on patients who underwent HSCT between November/2009-April/2017. Pulmonary complications were assessed at 30, 31-100, and 101-365 days post-transplantation. The Kaplan-Meier method was used to assess overall survival at 1 year. Results A total of 191 HSCT were performed on 184 patients during the study period. Seventy-one patients were female. There were 141 autologous HSCT (auto-HSCT) and 50 allogeneic HSCT (allo-HSCT), mean age of 49.4 years and 31.8 years respectively. The cumulative incidence for pulmonary complications in the present cohort was 22.69% and density incidence of 30.8 per 10.000 persons-days. The cumulative incidence for pulmonary complication was 19.72% in auto-HSCT and 16.68% in allo-HSCT. The most common type of pulmonary complication was infectious for both auto- and allo-HSCT. Analyzing risk factors for infectious pulmonary complications in auto-HSCT, a Karnofsky score of 60 in the performance status scale showed a RR of 42 (CI95%:1.3-1268.8, p=0.03) 31-100 days post-transplantation. Analyzing risk factors for non-infectious complications in auto-HSCT, undergoing a second transplantation showed a RR of 26.7 (CI95%:1.45-492, p=0.027) at 30 days, RR of 13.3 (CI95%:1.02-172.2, p=0.048) 31-100 days, and RR of 6.2 (CI95%:1-38, p=0.049) 101-365 days post-transplantation. Overall survival for pulmonary complications after HSCT was 79.9% (CI95%:0.708-0.86) for auto-HSCT and 85.7% (CI95%:0.708-0.93) for allo-HSCT at 1 year. Conclusion The present cohort had a lower cumulative incidence for both infectious and non-infectious pulmonary complications post-HSCT than the reported in the literature.