Risk factors for interstitial pneumonia following bone marrow transplantation for severe aplastic anaemia

Br J Haematol. 1989 Apr;71(4):535-43. doi: 10.1111/j.1365-2141.1989.tb06314.x.

Abstract

Data from 547 patients with aplastic anaemia who received bone marrow transplants from HLA-identical siblings were analysed to determine factors associated with the risk of interstitial pneumonia (IPn). IPn developed in 92 patients (17%). 37% of cases were associated with cytomegalovirus infection and 22% with other organisms; in 41% of cases no organism was identified. The case fatality rate was 64%; the mortality rate due to IPn was 11%. In multivariate analysis, four factors were associated with an increased probability of interstitial pneumonia: use of methotrexate rather than cyclosporine after transplantation (relative risk, 2.8; P less than 0.0008); occurrence of moderate to severe acute graft-versus-host disease (relative risk, 2.2; P less than 0.002); inclusion of total body radiation in the pretransplant preparative regimen (relative risk 2.2, P less than 0.004); and patient age greater than 20 (relative risk 1.7, P less than 0.002). The probability of IPn ranged from 4% for patients with none of these adverse risk factors to 51% (relative risk of 13.4) for patients with all four. The incidence of IPn decreased significantly between 1978 and 1985, paralleling a decrease in the use of total body radiation pretransplant for immune suppression and methotrexate post-transplant for prophylaxis against graft-versus-host disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Aplastic / complications
  • Anemia, Aplastic / mortality
  • Anemia, Aplastic / therapy*
  • Bone Marrow Transplantation*
  • Child
  • Child, Preschool
  • Female
  • Graft vs Host Disease / drug therapy
  • Graft vs Host Disease / etiology
  • Humans
  • Infant
  • Male
  • Methotrexate / adverse effects
  • Middle Aged
  • Postoperative Complications / etiology*
  • Pulmonary Fibrosis / etiology*
  • Pulmonary Fibrosis / mortality
  • Radiotherapy / adverse effects
  • Risk Factors

Substances

  • Methotrexate