Incidence, etiology, and outcome of pleural effusions in allogeneic hematopoietic stem cell transplantation

Abstract

Pleural effusion is a known entity in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT); however, the incidence, risk factors, and morbidity2mortality outcomes associated with pleural effusions remain unknown. We retrospectively evaluated pleural effusions in 618 consecutive adult patients who underwent allogeneic HSCT from January 2008 to December 2013 at our institution. Seventy one patients developed pleural effusion at a median of 40 days (range, 1 2 869) post-HSCT with the cumulative incidence of 9.9% (95% CI, 7.7 2 12.5%) at 1 year. Infectious etiology was commonly associated with pleural effusions followed by volume overload and serositis type chronic GVHD. In multivariate analysis, higher comorbidity index (P 5 0.03) and active GVHD (P 5 0.018) were found to be significant independent predictors for pleural effusion development. Higher comorbidity index, very high disease risk index, 7/8 HLA matching, and unrelated donor were associated with inferior overall survival (OS) (P < 0.03). More importantly, patients with pleural effusion were noted to have poor OS in comparison to patients without pleural effusion (P < 0.001). Overall, pleural effusion is a frequently occurring complication after allogeneic HSCT, adding to morbidity and mortality and hence, early identification is required.Am. J. Hematol. 91:E341-E347,

Possible involvement of IL‐6‐producing tissue‐resident macrophages in early‐onset pericardial effusion pathogenesis after hematopoietic stem cell transplantation

“…Myeloablative conditioning regimens result in cellular damage and death that produce sterile inflammatory immune response through the release of endogenous innate immune‐stimulatory molecules referred to as damage‐associated molecular patterns . From this point of view, frequently observed early‐onset pleural effusion might be caused by the endogenous mediator‐induced pleural macrophages irrespective of infection …”

Multistate models on pleural effusion after allogeneic hematopoietic stem cell transplantation

“…1(a). 2 As mentioned before, with this Cox model, it is hardly to assess the effect of the occurrence order of PE and GVHD on time to death because this approach allows the model to have only one final state without intermediate state.…”

“…2 In this study, a total of eight covariates are considered such as seven categorical covariates, age ((0,40],(40,60],(60,100], with (0,40] as reference category), sex (female, male, with female as reference category), race (African American, European American, others, with African American as reference category), conditioning regimen (full, reduced, with full as reference category), human leukocyte antigen (HLA) match (7/8,8/8,<7/8, with 7/8 as reference category), donor (matched-related, matched-unrelated, with matched-related as reference category), and disease risk index (very high, high, intermediate, low, with very high as reference category), and one continuous covariate, comorbidity index. Because the multivariable analysis requires a complete data without missing, we removed the patients with missing values, resulting in a total of 606 patients.…”

“…This type of complication occurs as a manifestation of direct lung injury from chemotherapeutic regimens, infections, graft versus host disease (GVHD), or a result from multiorgan failure. 2 Other common pulmonary complications include pulmonary infections (e.g., bacterial, viral, fungal), pulmonary edema, diffuse alveolar hemorrhage, bacterial sinopulmonary syndrome, idiopathic pneumonia syndrome, bronchiolitis obliterans, and GVHD involving lungs.…”

“…Therefore, Modi et al recently conducted a retrospective study to evaluate all aspects of symptomatic PEs in 618 consecutive adult patients, who underwent allogeneic HSCT, and concluded that PE is a regularly occurring complication after allogeneic HSCT requiring early identification. 2 In particular, in order to assess the effects of PE and GVHD on overall survival and to account for that each patient has different event time data, PE and GVHD were considered as time-varying covariates using Cox proportional hazard regression models, resulting that PE is an independent predictor but GVHD is not. However, this approach is unable to investigate the effect of occurrence order.…”