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Risk factors for interstitial pneumonia following bone marrow transplantation for severe aplastic anaemia
Author(s) -
Weiner Roy S.,
Horowitz Mary M.,
Gale Robert Peter,
Dicke Karel A.,
Bekkum Dirk W.,
Masaoka Tohru,
Ramsay Norma K. C.,
Rimm Alfred A.,
Rozman Ciril,
Bortin Mortimer M.
Publication year - 1989
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1989.tb06314.x
Subject(s) - medicine , methotrexate , relative risk , risk factor , gastroenterology , case fatality rate , incidence (geometry) , surgery , pneumonia , aplastic anemia , bone marrow , transplantation , immunology , epidemiology , confidence interval , physics , optics
S ummary . 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<0.0008); occurrence of moderate to severe acute graft‐versus‐host disease (relative risk, 2.2; P<0.002); inclusion of total body radiation in the pretransplant preparative regimen (relative risk 2.2, P<0.004); and patient age >20 (relative risk 1.7, P<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‐versushost disease.