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Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality

Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of hematopoietic cellular therapy (HCT). This study aimed to evaluate the effect of DAH treatments on outcomes using data from consecutive HCT patients clinically diagnosed with DAH from 3 institutions between January 2018-August 2...

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Autores principales: Schoettler, Michelle L., Dandoy, Christopher E., Harris, Anora, Chan, Marilynn, Tarquinio, Keiko M., Jodele, Sonata, Qayed, Muna, Watkins, Benjamin, Kamat, Pradip, Petrillo, Toni, Obordo, Jeremy, Higham, Christine S., Dvorak, Christopher C., Westbrook, Adrianna, Zinter, Matt S., Williams, Kirsten M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10399223/
https://www.ncbi.nlm.nih.gov/pubmed/37546403
http://dx.doi.org/10.3389/fonc.2023.1232621
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author Schoettler, Michelle L.
Dandoy, Christopher E.
Harris, Anora
Chan, Marilynn
Tarquinio, Keiko M.
Jodele, Sonata
Qayed, Muna
Watkins, Benjamin
Kamat, Pradip
Petrillo, Toni
Obordo, Jeremy
Higham, Christine S.
Dvorak, Christopher C.
Westbrook, Adrianna
Zinter, Matt S.
Williams, Kirsten M.
author_facet Schoettler, Michelle L.
Dandoy, Christopher E.
Harris, Anora
Chan, Marilynn
Tarquinio, Keiko M.
Jodele, Sonata
Qayed, Muna
Watkins, Benjamin
Kamat, Pradip
Petrillo, Toni
Obordo, Jeremy
Higham, Christine S.
Dvorak, Christopher C.
Westbrook, Adrianna
Zinter, Matt S.
Williams, Kirsten M.
author_sort Schoettler, Michelle L.
collection PubMed
description Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of hematopoietic cellular therapy (HCT). This study aimed to evaluate the effect of DAH treatments on outcomes using data from consecutive HCT patients clinically diagnosed with DAH from 3 institutions between January 2018-August 2022. Endpoints included sustained complete response (sCR) defined as bleeding cessation without recurrent bleeding, and non-relapse mortality (NRM). Forty children developed DAH at a median of 56.5 days post-HCT (range 1-760). Thirty-five (88%) had at least one concurrent endothelial disorder, including transplant-associated thrombotic microangiopathy (n=30), sinusoidal obstructive syndrome (n=19), or acute graft versus host disease (n=10). Fifty percent had a concurrent pulmonary infection at the time of DAH. Common treatments included steroids (n=17, 25% sCR), inhaled tranexamic acid (INH TXA,n=26, 48% sCR), and inhaled recombinant activated factor VII (INH fVIIa, n=10, 73% sCR). NRM was 56% 100 days after first pulmonary bleed and 70% at 1 year. Steroid treatment was associated with increased risk of NRM (HR 2.25 95% CI 1.07-4.71, p=0.03), while treatment with INH TXA (HR 0.43, 95% CI 0.19- 0.96, p=0.04) and INH fVIIa (HR 0.22, 95% CI 0.07-0.62, p=0.005) were associated with decreased risk of NRM. Prospective studies are warranted to validate these findings.
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spelling pubmed-103992232023-08-04 Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality Schoettler, Michelle L. Dandoy, Christopher E. Harris, Anora Chan, Marilynn Tarquinio, Keiko M. Jodele, Sonata Qayed, Muna Watkins, Benjamin Kamat, Pradip Petrillo, Toni Obordo, Jeremy Higham, Christine S. Dvorak, Christopher C. Westbrook, Adrianna Zinter, Matt S. Williams, Kirsten M. Front Oncol Oncology Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of hematopoietic cellular therapy (HCT). This study aimed to evaluate the effect of DAH treatments on outcomes using data from consecutive HCT patients clinically diagnosed with DAH from 3 institutions between January 2018-August 2022. Endpoints included sustained complete response (sCR) defined as bleeding cessation without recurrent bleeding, and non-relapse mortality (NRM). Forty children developed DAH at a median of 56.5 days post-HCT (range 1-760). Thirty-five (88%) had at least one concurrent endothelial disorder, including transplant-associated thrombotic microangiopathy (n=30), sinusoidal obstructive syndrome (n=19), or acute graft versus host disease (n=10). Fifty percent had a concurrent pulmonary infection at the time of DAH. Common treatments included steroids (n=17, 25% sCR), inhaled tranexamic acid (INH TXA,n=26, 48% sCR), and inhaled recombinant activated factor VII (INH fVIIa, n=10, 73% sCR). NRM was 56% 100 days after first pulmonary bleed and 70% at 1 year. Steroid treatment was associated with increased risk of NRM (HR 2.25 95% CI 1.07-4.71, p=0.03), while treatment with INH TXA (HR 0.43, 95% CI 0.19- 0.96, p=0.04) and INH fVIIa (HR 0.22, 95% CI 0.07-0.62, p=0.005) were associated with decreased risk of NRM. Prospective studies are warranted to validate these findings. Frontiers Media S.A. 2023-07-20 /pmc/articles/PMC10399223/ /pubmed/37546403 http://dx.doi.org/10.3389/fonc.2023.1232621 Text en Copyright © 2023 Schoettler, Dandoy, Harris, Chan, Tarquinio, Jodele, Qayed, Watkins, Kamat, Petrillo, Obordo, Higham, Dvorak, Westbrook, Zinter and Williams https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Schoettler, Michelle L.
Dandoy, Christopher E.
Harris, Anora
Chan, Marilynn
Tarquinio, Keiko M.
Jodele, Sonata
Qayed, Muna
Watkins, Benjamin
Kamat, Pradip
Petrillo, Toni
Obordo, Jeremy
Higham, Christine S.
Dvorak, Christopher C.
Westbrook, Adrianna
Zinter, Matt S.
Williams, Kirsten M.
Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality
title Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality
title_full Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality
title_fullStr Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality
title_full_unstemmed Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality
title_short Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality
title_sort diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10399223/
https://www.ncbi.nlm.nih.gov/pubmed/37546403
http://dx.doi.org/10.3389/fonc.2023.1232621
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