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. 2021 Sep;56(9):2097-2107.
doi: 10.1038/s41409-021-01293-y. Epub 2021 Apr 12.

Risk factors and outcomes of diffuse alveolar haemorrhage after allogeneic haematopoietic stem cell transplantation

Jin Wu  1   2   3   4 , Hai-Xia Fu  1   2   3   4 , Yun He  1   2   3   4 , Xiao-Dong Mo  1   2   3   4 , Xiao Liu  1   2   3   4 , Xuan Cai  1   2   3   4 , Ruo-Yun Gui  1   2   3   4 , Hui-Xin Liu  5 , Chen-Hua Yan  1   2   3   4 , Yu-Hong Chen  1   2   3   4 , Ying-Jun Chang  1   2   3   4 , Lan-Ping Xu  1   2   3   4 , Kai-Yan Liu  1   2   3   4 , Xiao-Jun Huang  1   2   3   4 , Xiao-Hui Zhang  6   7   8   9
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Risk factors and outcomes of diffuse alveolar haemorrhage after allogeneic haematopoietic stem cell transplantation

Jin Wu et al. Bone Marrow Transplant. 2021 Sep.

Abstract

Diffuse alveolar haemorrhage (DAH) is a life-threatening pulmonary complication occurring after allogeneic haematopoietic stem cell transplantation (allo-HSCT) without an explicit aetiology or a standard treatment. This study aimed to explore the occurrence and prognosis of DAH after allo-HSCT, in addition to comparing discrepancies in the incidence, clinical characteristics and outcomes of DAH between patients undergoing haploidentical HSCT (HID-HSCT) and matched related donor HSCT (MRD-HSCT). We retrospectively evaluated 92 consecutive patients among 3987 patients with a confirmed diagnosis of DAH following allo-HSCT (HID: 71 patients, MRD: 21 patients). The incidence of DAH after allo-HSCT was 2.3%, 2.4% after HID-HSCT and 2.0% after MRD-HSCT (P = 0.501). The prognosis of patients with DAH after transplantation is extremely poor. The duration of DAH was 7.5 days (range, 1-48 days). The probabilities of overall survival (OS) were significantly different between patients with and without DAH within 2 years after transplantation (P < 0.001). According to the Cox regression analysis, a significant independent risk factor for the occurrence of DAH was delayed platelet engraftment (P < 0.001), and a high D-dimer level (>500 ng/ml) was a significant risk factor for the poor prognosis of DAH. HID-HSCT is similar to MRD-HSCT in terms of the outcomes of DAH.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patients included in the present analysis.
Fig. 2
Fig. 2. Comparison of overall survival following allo-HSCT.
a Patients with DAH and controls following allo-HSCT; b Patients with DAH and controls following HID-HSCT; c Patients with DAH and controls following MRD-HSCT; d Patients with DAH following MRD-HSCT or HID-HSCT.
Fig. 3
Fig. 3. OS of patients with DAH treated with different doses of glucocorticoid.
a Patients with DAH following allo-HSCT; b Patients with DAH following HID-HSCT and MRD-HSCT.
Fig. 4
Fig. 4. OS of patients with DAH treated with/without intubation.
a Patients with DAH following allo-HSCT; b Patients with DAH following HID-HSCT and MRD-HSCT.
See this image and copyright information in PMC

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