Risk Factor Analysis Of Idiopathic Pneumonia Syndrome After Allogeneic Hematopoietic Stem Cell Transplantation In Children

Idiopathic pneumonia syndrome (IPS) is a critical complication following allogeneic hematopoietic stem cell transplantation (HSCT); however, few reports have analyzed the risk factors for IPS in children. A total of 210 consecutive pediatric patients, including 131 boys and 79 girls, with various hematologic malignancies, aplastic anemia, or solid tumors who underwent allogeneic HSCT were analyzed to clarify the incidence and risk factors for IPS. Patient and transplantation characteristics after allogeneic HSCT were compared between patients with and without IPS. Cumulative incidence rates of IPS 120 days after allogeneic HSCT were 6.7% (14/210). Of 14 patients with IPS, 11 (78.6%) died after developing IPS. The presence of prior HSCT was more frequent in patients with IPS (IPS group) than in those without (non-IPS group) (35.7 vs 12.8%, respectively, P=0.018). The IPS group contained more patients with acute GVHD (grade II-IV) than the non-IPS group (50.0 vs 18.9%, respectively, P=0.006). The association of these two factors with IPS was further confirmed by multivariate analysis. We should be aware of these risk factors in patients who have undergone allogeneic HSCT. The rapid progression to respiratory failure and high mortality rate following the onset of IPS, despite advances in supportive care, require the development of new preventive measures and treatment modalities. Further preclinical and clinical studies are required to understand the pathogenesis of IPS and improve the prognosis of HSCT recipients.