Pulmonary complications post allogeneic haematopoietic stem cell transplant in children

Objectives.Haematopoietic stem cell transplant (HCT) is a cellulartherapy that, whilst curative for a child's underlying disease, carriessignificant risk of mortality, including because of pulmonarycomplications. The aims of this study were to describe the burden ofpulmonary complications post-HCT in a cohort of Australian childrenand identify risk factors for the development of these complications. Methods.Patients were identified from the HCT databases at twopaediatric transplant centres in Australia. Medical records werereviewed, and demographics, HCT characteristics and pulmonarycomplications documented. Relative risk ratio was used to identifyrisk factors for developing pulmonary complications prior to firsttransplant episode, and survival analysis performed to determinehazard ratio.Results.In total, 243 children underwent transplantduring the study period, and pulmonary complications occurred in48% (117/243) of children. Infectious complications were morecommon (55%) than non-infective complications (18%) and 26% ofpatients developed both. Risk factors for the development ofpulmonary complications included the following: diagnoses ofMPAL (RR 2.16,P=0.02), matched unrelated donor (RR1.34,P=0.03), peripheral blood (RR 1.36,P=0.028) or cord blood (RR1.73,P=0.012) as the stem cell source and pre-existing lung disease(RR1.72,P<0.0001). Children with a post-HCT lung complicationhad a significantly increased risk of mortality compared with thosewho did not (HR 3.9,P<0.0001). Conclusion. This study demonstrates pulmonary complications continue to occurfrequently in children post-HCT and contribute significantly tomortality. Highlighting the need for improved strategies to identifypatients at risk pre-transplant and enhanced treatments for thosewho develop lung disease