Cargando…
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...
Autores principales: | , , , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1785084224816021504 |
---|---|
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. |
format | Online Article Text |
id | pubmed-10399223 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT schoettlermichellel diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT dandoychristophere diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT harrisanora diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT chanmarilynn diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT tarquiniokeikom diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT jodelesonata diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT qayedmuna diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT watkinsbenjamin diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT kamatpradip diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT petrillotoni diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT obordojeremy diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT highamchristines diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT dvorakchristopherc diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT westbrookadrianna diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT zintermatts diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality AT williamskirstenm diffusealveolarhemorrhageafterhematopoieticcelltransplantationresponsetotreatmentsandriskfactorsformortality |