Analysis Of Risk Factors For Pulmonary Chronic Graft-versus-Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation

Objective:To analyze the incidence,clinical features and risk factors of pulmonary chronic graft-versus-host disease?cGVHD?in patients with hematological diseases after allogeneic hematopoietic stem cell transplantation?Allo-HSCT?,and to analyze the impact of pulmonary cGVHD on long-term survival of patients.Methods:We summarized the clinical data of 93 patients who underwent allogeneic hematopoietic stem cell transplantation in our hospital from January 01,2010 to October 10,2018,and survived more than 100 days after transplantation.We retrospectively analyzed the incidence and clinical features of pulmonary cGVHD,and the influence of age,disease nature,lung infection before and after transplantation,merging aGVHD or not,HLA matching in donor and recipient,the time interval between disease diagnosis and transplantation on the occurrence of pulmonary cGVHD were analyzed with statistic.Results:A total of 16 patients in 93 patients had pulmonary cGVHD,with a cumulative prevalence rate of 17.20%,and usually developed within 2 years after transplantation?15/16?.Among patients with pulmonary cGVHD,patients aged?10years older were more than patients aged<10 years older,patients with hematologic malignancies were more than non-malignant hematologic patients,and HLA matched transplantation and haploidentical transplantation were equal in number,but the incidence of pulmonary cGVHD in HLA haploidentical transplantation was greater than that in HLA matched transplantation?21.05%vs.14.55%?,patients with previous aGVHD were more than patients without previous aGVHD and all patients with pulmonary cGVHD had localized or extensive cGVHD manifestations.Patients with pulmonary cGVHD were mainly cough,asthma,and dyspnea.The pulmonary function tests showed a significant decrease in FEV_1.0/FVC and FEV_1.0/predicted values,and signs of mosaic signs and bronchiectasis in the lungs were observed by high-resolution chest CT.Univariate analysis showed that patients aged?10 years older?P=0.007?,hematologic malignancies?P=0.019?,pre-transplant lung fungal infections?P<0.001?,,combined with aGVHD?P<0.001?and extrapulmonary cGVHD?P<0.001?were risk factors for the pulmonary cGVHD,The cumulative survival rate of pulmonary cGVHD group after transplantation was?27.9±20.9?%,and the cumulative survival rate of patients without pulmonary cGVHD group was?83.6±6.4?%.The difference of cumulative survival rate between the two groups was statistically significant?P=0.033?.Conclusion:Pulmonary cGVHD is one of the common complications after stem cell transplantation,the cumulative prevalence rate is 17.20%and the mortality rate is high,which is the main factor affecting the long-term survival of patients after transplantation.Patients aged?10 years older,hematologic malignancies,pre-transplant lung fungal infections,combined with aGVHD and extrapulmonary cGVHD are risk factors for the pulmonary cGVHD.