A Clinical Study Of Interstitial Pneumonia After Allogeneic Peripheral Blood Stem Cell Transplantation

Objective:To explore clinical feature,the early diagnosis and curative effect analysis of early prophylaxis and early treatment in Interstitial Pneumonia(IP) after Allogeneic Peripheral Blood Stem Cell Transplantation(allo-PBSCT).Methods:We carried out clinical analysis to 71 patients who had accepted allo-PBSCT from March,2004 to August,2007 in our hospital. Among them,46 patients were male,25 patients were female.40 patients were HLA all coincided, 31 patients were HLA haploid coincided. The conditioning regimen was myeloablative in all these patients. The prophylaxis of graft-versus-host disease (GVHD):The patients who were HLA all coincided received cyclosporine A (CsA), short-range methotrexate(MTX) and some of them received mycophenodate mofetil (MMF); The patients who were HLA haploid coincided also received CsA and short-range MTX,all of them received MMF,antithymocyte globulin (ATG) and anti-CD25. We used drugs to all these patients to resist virus,bacterium,fungi and pneumocystis carinii.The mainstay of diagnosis are as follows: typical example clinical situation of fever,dry cough,anhelation,tachypnea and hypoxemia in progress; imageology manifestation of interstitial alteration in bellows CT,successive blood gas monitoring reflection of hypoxemia in progress and aetiology detection such as CMV.The therapy of IP are as follows:We administ methylprednisolone as the main drug, and admove broad-spectrum antibiotic to resist bacterium and CMV in experience. We should monitor blood gas,interstitial alteration in bellows CT and clinical manifestation, if these correlated indexes cannot to be improved in short term, we should use antimycotic drugs early. Results: 18 of 71 patients who underwent allo-PBSCT suffered from IP, incidence rate is 25.35%. In 18 IP patients,13 IP patients improved,5 IP patients died.The total effective rate of IP treatment is 72%, the death rate of IP is 28%.3 IP patients occurred acute GVHD(Ⅱ～Ⅲdegree),11 IP patients occurred chronic GVHD(Ⅰ～Ⅱdegree). The most common adverse events of Ganciclovir (DHPG) were leukopenia and thrombocytopenia, but both of them were reversible. Conclusion: Early prophylaxis, early diagnosis and early treatment are very important to IP. The earlier overall prophylaxis of IP to resist virus,bacterium,fungi and pneumocystis carinii is utility. We administ methylprednisolone as the main drug, and admove broad-spectrum antibiotic to resist bacterium and CMV in experience. if the correlated indexes of IP cannot to be improved in short term, we should use antimycotic drugs early. Therapeutic alliance of IP treatment have a fine effect. We must pay attention to adverse effect of medicine to treat IP,early to discover,early to handle.