Multivariate Analysis Of Risk Factors For Idiopathic Pneumonia Syndrome Early After Allogeneic Hematopoietic Stem Cell Transplantation

Objective: To investigate the incidence, diagnosis, clinical course and risk factors of Idiopathic Pneumonia Syndrome (IPS) following allogeneic hematopoietic stem cell transplantation (allo-HSCT), and explore the possible pathogenesis.Method: We retrospectively analyzed 19 cases of IPS from 167 patients undergoing allo-HSCT from April, 1997 to December, 2006. The 13 clinical parameters were selected for Logistic univariate analysis: age, sex, underlying diagnosis, disease status at transplant, transplant type, condition regimens, donor type, presence or absence of aGVHD, severity of aGVHD, HLA disparity, aGVHD of skin, liver and gut to identify risk factors for the development of IPS. Factors that were significant at the 0.1 level on univariate analysis were evaluated by multivariate analysis using a Logistic regression. The study also involved the assessment of clinical manifestation and diagnosis of IPS, and the discussion of the possible pathogenesis.Results: 19 of 167 patients developed IPS (11.4%). Median time to IPS onset after allo-HSCT was 83 days (range 32-120days); Median time to death after the diagnosis of IPS was 9 days (range 3～92 days); 18 patients with IPS died because of the rapid progression of respiratory failure (94.7%). 18 patients with IPS developed aGVHD (94.7%), with aGVHD of gut in 15 patients (83.3%). The following 6 factors were associated with an increased risk of IPS by univariate analysis: advanced disease, unrelated donor, HLA disparity, presence of aGVHD, aGVHDⅢ～Ⅳand aGVHD of gut. These risk factors were entered into a multivariate analysis model. Only unrelated donor, aGVHDⅢ～Ⅳand gut aGVHD are identified as being significantly associated with the occurrence of IPS by a multivariate analysis.Conclusion: Patients were at increased risk of IPS if they had received graft from unrelated donor or they developed gradeⅢ～ⅣaGVHD, especially aGVHD of gut. IPS possibly represents acute graft-versus-host disease involving the lung, and the lung may be a target of acute graft-versus-host-disease.