Clinical Research On Pulmonary GVHD Patients After Allogeneic Hematopoietic Stem Cell Transplantation

Backgroumd and 0bjective:Allogeneic hematopoietic stem cell transplantation(allo-SCT)is an effective therapy for many hematologic non-malignancies or malignancies.In long-term follow-up after transplantation,graft versus host disease(GVHD),with multiple systems involved,remains a major cause of non-relapse mortality.For the past few years,there's increasing study and focus on pulmonary GVHD.To describe the basic characteristics,risk factors,and clinical features of pulmonary GVHD patients after a llo-SCT.Methods:The clinical data of 648 patients underwent allo-SCT in Chinese PLA General Hospital from January 1,2006 to January 1,2018 were retrospectively analyzed.The risk factors of pulmonary GVHD after allogeneic hematopoietic stem cell transplantation were analyzed by comparing the clinical data of patients with and without pulmonary GVHD.To summarize the basic characteristics and clinical featuresof patients with pulmonary GVHD.Results:1.Basic characteristics:O f the 648 patients,35 were diagnosed with pulmonary GVHD,including 21 males and 14 females.The onset time was 80 to2732 days after transplantation,median time was 401(215,790)days after transplantation.At the time of transplantation,the age ranged from 14 to 53 years old,the median age was 29(23.5,38.5)years old.2.Analysis of the risk factor results showed that the incidence of pulmonary GVHD after sibling sibling complete compatibility transplantation was significantly higher than that of haploid transplantation group(P=0.016),and the determination of CD4+lymphocyte subpopulation was significantly more active in the case group than the control group(P=0.001).The other clinical factors showed no significant difference between the two groups.3.The chest CT findings of 35 patients all showed bronchiectasis and bronchial wall thickening,11 cases(31.43%)were accompanied by pleural hypertrophy,9 cases(25.71%)were accompanied by Mosaic signs,and 3 cases(8.57%)were accompanied by mediastinal emphysema.The results of lung function of 14 patients were as follows:obstructive ventilation dysfunction in 2 cases(14.28%),restricted ventilation dysfunction in 2 cases(14.28%),mixed ventilation dysfunction in 9 cases(61.28%),and normal ventilation function in 1 case(7.14%).Conclusions:The male-female ratio of patients with pulmonary GVHD was 1.5:1.Patients who received full-sibling transplantation had a higher incidence of pulmonary GVHD after surgery.CD4~+lymphocytes in patients with pulmonary GVHD were significantly more active than those without chronic GVHD.C hest CT of patients with pulmonary GVHD mainly showed bronchiectasis and thickening of bronchial wall,and pleural thickening may be the early manifestation.The lung function was dominated by mixed ventilation dysfunction,and most of them were accompanied by diffusion dysfunction.