Atopy Predicts Pulmonary Complications After Transplantation
High-Dose Therapy and Autologous Hematopoietic Cell
Transplantation in Children With Primary Refractory and
Relapsed Hodgkin's Disease: Atopy Predicts Idiopathic
Diffuse Lung Injury Syndromes
Jennifer Frankovich, Sarah S.Donaldson, Yisheng Lee, Ruby
M.Wong, Michael Amylon, Michael R.Verneris
Biology of Blood and Marrow Transplantation 7:49-57 (2001)
© 2001 American Society for Blood and Marrow Transplantation
The use of high-dose therapy (HDT) and autologous
hematopoietic cell transplantation (AHCT) for children and
adolescents with primary refractory and relapsed Hodgkin's
disease is increasing. The purpose of this retrospective
analysis was to: (1) evaluate the outcome of HDT and AHCT in
pediatric patients with Hodgkin's disease, and (2) identify
factors that predispose patients to the development of
transplantation-related complications. We describe the
experiences of 34 pediatric patients from a single
institution with primary refractory or relapsed Hodgkin's
disease. HDT regimens consisted of cyclophosphamide and
etoposide combined with either carmustine,
chloroethylcyclohexylnitrosurea, or fractionated total body
irradiation. Kaplan-Meier survival predicts that 67% (95%
confidence interval [CI] 47%-87%) of patients will be alive
and disease-free at 5 years. Nine patients had disease
recurrence, of whom 5 relapsed after 1 year (1.5-6.3 years).
Five patients succumbed to treatment-related toxicities, of
whom 4 died of pulmonary failure. Fifteen patients (44%)
developed post-AHCT idiopathic diffuse lung injury syndrome:
acute alveolitis (n = 2); diffuse alveolar hemorrhage (n =
2); acute respiratory distress syndrome (n = 2); delayed
interstitial pneumonitis (n = 8); and bronchiolitis
obliterans (n = 1). The following factors did not predict
for the development of a diffuse lung injury syndrome in
univariate analysis: prior treatment with bleomycin, pre-HDT
pulmonary function tests, and prior thoracic irradiation. Of
the patients in our cohort, 44% had a history of atopy
(allergic rhinitis and/or asthma). Multivariate logistic
analysis revealed that a preexisting his-tory of atopy was
highly predictive of idiopathic pulmonary complications (P =
.0001, odds ratio = 21, CI 3.6-125). Our experience shows
that HDT followed by AHCT results in durable remissions in
two thirds of pediatric patients with refractory and
relapsed Hodgkin's disease, and a history of atopy is
associated with post-AHCT pulmonary complications.
 7.1.Frankovich.pdf
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