PT  - JOURNAL ARTICLE
AU  - Marco Brunori
AU  - Serena Melandri
AU  - Stephane K. Nkwenze
AU  - Gloria Pane
AU  - Luigi Panza
AU  - Eugenia Pipitone
AU  - Stefano Ungaro
AU  - Daniela Parola
TI  - Late-onset non-infectious pulmonary complications after allogenic-stem cell transplant (LONIPC). Results of treatment strategy with multidisciplinary cooperation
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - P780
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/P780.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/P780.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - Pulmonary complications are a major cause of morbidity and mortality in patients undergoing allogenic stem cell transplant (HSCT). If advances in prophylaxis and treatment of HSCT-related infections have significantly improved, it's not the same for the non-infectious counterparts. Our aim was to improve management of LONIPC through evaluation of clinical and functional response to targeted therapies and define standardized time points to start specific therapies in pre-symptomatic stage to decrease morbidity and mortality. From 2010 we analyzed 25 consecutive adult patients in follow-up at a median time of 35 months post-HSCT with a normal lung function before HSCT. 14/25 had a ventilatory defect: obstructive (OD)8; restrictive (RD)5; mixed (MD)1. They were treated by ICS-LABA and tiotropium for mild/moderate OD (4 pts); as above + oral prednisone (PDN), acetyilcistein, pulmonary rehab with respiratory devices (Ez-pap) for severe OD (4 pts); oral PDN, acetyilcistein and pulmonary rehab (Cliniflo), for RD (5 pts). Oral PDN and inhaled BD for MD (1 pts).7 patients were in treatment for GVHD, that remained stable. The 2-year cumulative incidence of response to therapy was 76%; 3/14 died of LONIPC, with a 15 year overall survival of 35%. TBI pre-HSCT was the only variable associated with a worse response to therapy. LONIPC appear early after HSCT, even if with mild clinical or spirometric signs; the cooperation between pneumologists and hematologists allows its early recognition and specific treatments with good response, avoiding clinical evolution, gaining better QOL and reducing the employment of anti-GVHD therapy.