Association between early corticosteroid administration and long-term survival in non-infectious pulmonary complications after allogeneic hematopoietic stem cell transplantation

• Published in: International journal of hematology Vol. 117; no. 4; pp. 578 - 589
• Main Authors: Kambara, Yui, Fujii, Nobuharu, Usui, Yoshiaki, Yamamoto, Akira, Higo, Hisao, Fujiwara, Hideaki, Asada, Noboru, Ennishi, Daisuke, Nishimori, Hisakazu, Fujii, Keiko, Matsuoka, Ken-ichi, Maeda, Yoshinobu
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-04-2023; Springer Nature B.V
• Subjects: Adrenal Cortex Hormones - adverse effects; Bronchiolitis obliterans; Bronchiolitis Obliterans - etiology; Bronchopneumonia; Complications; Corticoids; Corticosteroids; Diagnosis; Fatalities; Health services; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Idiopathic pneumonia syndrome; Lung diseases; Lung Diseases, Interstitial; Lung transplantation; Medicine; Medicine & Public Health; Oncology; Original; Original Article; Pneumonia; Prednisolone; Retrospective Studies; Stem cell transplantation; Stem cells; Steroids; Survival; Transplantation; Interstitial lung disease (ILD); Non-infectious pulmonary complications (NIPCs); Bronchiolitis obliterans (BO); Prednisolone; Idiopathic pneumonia syndrome (IPS)
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-022-03517-3

Non-infectious pulmonary complications (NIPCs) after allogeneic hematopoietic stem cell transplantation (HSCT) are associated with poor outcomes. It is important to maximize the effectiveness of primary treatment because secondary treatment has not been established. We analyzed data from 393 patients who underwent allogeneic HSCT during a 10-year period. Thirty-seven were diagnosed with NIPCs, which consisted of idiopathic pneumonia syndrome, bronchiolitis obliterans, and interstitial lung disease including cryptogenic organizing pneumonia. Among these, 18 died (Dead group) while 19 remained alive (Alive group) during the study period. The median time between NIPC diagnosis and first administration of ≥ 1 mg/kg/day corticosteroids (prednisolone dose equivalent) was significantly longer in the Dead group than the Alive group, at 9 days versus 4 days (
p
 = 0.01). We further divided these cases into those who received prednisolone within seven days and after 8 days. We found that the ≤ 7 days group were more likely to survive after their NIPC diagnosis compared to the ≥ 8 days group (
p
 = 0.06). Our analysis showed that early initiation of corticosteroid therapy is associated with long-term survival in NIPCs.