Interstitial Pneumonitis After Bone Marrow Transplantation

doi:10.1059/0003-4819-104-2-168

Interstitial Pneumonitis After Bone Marrow Transplantation

Assessment of Risk Factors

ROY S. WEINER, M.D.;
MORTIMER M. BORTIN, M.D.;
ROBERT PETER GALE, M.D., Ph.D.;
ELIANE GLUCKMAN, M.D.;
HUMPHREY E. M. KAY, F.R.C.Path.;
HANS-JOCHEM KOLB, M.D.;
ARTHUR J. HARTZ, M.D., Ph.D.; and
ALFRED A. RIMM, Ph.D.

Gainesville, Florida; Milwaukee, Wisconsin; Los Angeles, California
;
Paris
, France;
London
, England; and
Munich
, West Germany

Abstract

Data from 932 patients with leukemia who received bone marrow transplants were analyzed to determine factors associated with an increased risk of developing interstitial pneumonitis. Interstitial pneumonitis developed in 268 patients for a 2-year actuarial incidence of 35 ± 4% (SD) and with a mortality rate of 24%. Six factors were associated with an increased risk: use of methotrexate rather than cyclosporine after transplantation (relative risk, 2. 3; p < 0.0002); older age (relative risk, 2.1; p < 0.0001); presence of severe graft-versus-host disease (relative risk, 1.9; p ;< 0.003); long interval from diagnosis to transplantation (relative risk, 1.6; p < 0.002); performance ratings before transplantation of less than 100% (relative risk, 2.1; p < 0.0001); and high dose-rates of irradiation in patients given methotrexate after transplantation (relative risk, 3.2; p < 0.03). The risk of developing interstitial pneumonitis ranged from 8% in patients with none of these adverse risk factors to 94% in patients with all six. These findings may help to identify patients at high risk for this complication.

Article and Author Information

▸From the International Bone Marrow Transplant Registry and the Division of Medical Oncology and the Bone Marrow Transplantation Program, University of Florida College of Medicine, Gainesville, Florida; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Medicine, Division of Hematology-Oncology, UCLA Center for Health Sciences, Los Angeles, California; Service d'Hematologie, Hôpital St. Louis, Paris, France; Department of Clinical Pathology, Royal Marsden Hospital, London, England; Institut für Hämatologie, Munich, West Germany; Division of Biostatistics/Clinical Epidemiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Grant support: by Contract N01-AI-32532 from the National Institute of Allergy and Infectious Diseases and the National Cancer Institute; Contract BI0. C.520.US (H) from the Commission of the European Communities; the Jacob and Hilda Blaustein Foundation; Charles E. Culpeper Foundation; William Randolph Hearst Foundation; RGK Foundation; Lederle Laboratories; Ambrose Monell Foundation; Samuel Roberts Noble Foundation; Elsa U. Pardee Foundation; Sandoz, Inc.; Sandoz, Ltd.; the Swiss Cancer League; and the Upjohn Company.
▸Reprint requests should be addressed to Mortimer M. Bortin, M.D.; International Bone Marrow Transplant Registry, Medical College of Wisconsin, P.O. Box 26509; Milwaukee, WI 53226.