Pre-transplant risk factors for cryptogenic organizing pneumonia/ bronchiolitis obliterans organizing pneumonia after hematopoietic cell transplantation

H. Nakasone, M. Onizuka, N. Suzuki, N. Fujii, S. Taniguchi, K. Kakihana, H. Ogawa, K. Miyamura, T. Eto, H. Sakamaki, H. Yabe, Y. Morishima, K. Kato, R. Suzuki, T. Fukuda

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Abstract

Cryptogenic organizing pneumonia (COP), previously known as bronchiolitis obliterans organizing pneumonia (BOOP), is a significant complication after allogeneic hematopoietic SCT (HCT). However, the pathogenesis of this complication has not yet been elucidated. Therefore, we identified the pre-transplant risk factors for the development of COP/BOOP using the Japan transplant registry database between 2005 and 2009. Among 9550 eligible recipients, 193 experienced COP/BOOP (2%). HLA disparity (odds ratio (OR) 1.51, P=0.05), female-to-male HCT (OR 1.53, P=0.023), and PBSC transplant (OR 1.84, P=0.0076) were significantly associated with an increased risk of COP/BOOP. On the other hand, BU-based myeloablative conditioning (OR 0.52, P=0.033), or fludarabine-based reduced-intensity conditioning (OR 0.50, P=0.0011) in comparison with a TBI-based regimen and in vivo T-cell depletion (OR 0.46, P=0.055) were associated with a lower risk. Of the 193 patients with COP/BOOP, 77 died, including non-relapse death in 46 (59%). Pulmonary failure and fatal infection accounted for 41% (n=19) and 26% (n=12) of the non-relapse death. Allogeneic immunity and conditioning toxicity could be associated with COP/BOOP. Prospective studies are required to elucidate the true risk factors for COP/BOOP and to develop a prophylactic approach.

Original languageEnglish
Pages (from-to)1317-1323
Number of pages7
JournalBone Marrow Transplantation
Volume48
Issue number10
DOIs
Publication statusPublished - Oct 1 2013
Externally publishedYes

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All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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