Clinical characteristics of late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation

目的 了解异基因造血干细胞移植(allo-HSCT)后晚发重症肺炎的临床特点.方法 回顾性分析2009年3月至2013年1月在北京大学人民医院接受allo-HSCT后发生晚发重症肺炎患者的临床特点.结果 在行allo-HSCT的1538例患者中共有20例发生晚发重症肺炎,发生率为1.3％,其中同胞人类白细胞抗原(HLA)全相合移植17例(85％),半相合移植3例(15％).重症肺炎发生中位时间为移植后第227(150 ～ 690)天.14例(70％)发病时动脉氧分压低于60mmHg(1 mmHg=0.133 kPa).所有患者首发表现为胸部影像学异常,其中18例(90％)为双侧渗出性病变.全部患者发生重症肺炎时无活动性移植物抗宿主病表现.18例经验性或针对培养阳性病原的特异性抗细菌、真菌感染治疗无效.8例获得病原学证据.因呼吸衰竭治疗无效或死亡11例,治疗有效9例.6例接受供者淋巴细胞输注(DLI),输注后低氧血症及影像学改善4例,其中存活3例.结论 移植后晚发重症肺炎进展迅速,预后差.DLI可能成为提高晚发重症肺炎存活率的治疗手段.To analyze the clinical characteristics of the late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation (allo-HSCT).A retrospective study was conducted in patients diagnosed as late-onset severe pneumonia after allo-HSCT from March, 2009 to January, 2013 in People's Hospital of Peking University.Of 1538 patients receiving allo-HSCT, 20 developed late-onset severe pneumonia with an incidence rate of 1.3%. Among the 20 patients, 17(85%) had human leukocyte antigen (HLA) identical donors. The other 3(15%) patients had received haplo-identical transplantation. Severe pneumonia occurred at a median time of 227(150-690) days after allo-HSCT. Blood gas tests showed that 14 patients (70%) had arterial oxygen lower than 60 mm Hg (1 mm Hg = 0.133 kPa). All patients had abnormal findings in chest X-ray or CT scan images, 18 (90%) of whom represented bilateral infiltrative lesions. None of the patients had evidence of active graft-versus-host disease before or during pneumonia. Eighteen patients did not respond to empiric antibiotics, neither did 8 patients to targeted medications who had positive pathogens by culture. Eleven patients died of respiratory failure and 9 survived. Six patients received donor lymphocyte infusion (DLI), 4 of whom obtained improvement of chest images and 3 survived till the end of follow-up.The late-onset severe pneumonia after allo-HSCT represents an aggressive behavior with poor prognosis. DLI might be an effective way to improve its outcome.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)010819-8235