异基因造血干细胞移植后晚发重症肺炎的临床特点
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.
更多Objective To analyze the clinical characteristics of the late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods A retrospective study was conducted in patients diagnosed as late-onset severe pneumonia after allo-HSCT from March,2009 to January,2013 in Peoplc's Hospital of Pcking University.Results 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 8patients 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.Conclusions 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.
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