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Risk factors associated with interstitial pneumonia following allogeneic bone marrow transplantation for acute leukemia in Japanese experience.

Records of 101 patients with acute leukemia who received allogeneic bone marrow transplantation (BMT) with preparation using cyclophosphamide and total body irradiation (TBI) from September 1975 through July 1984 were collected into Japanese Bone Marrow Transplant Registry from 15 of the participating hospitals. These patients were divided into two groups by year of BMT. Group I included nine acute lymphocytic leukemia (ALL) and nine acute non-lymphocytic leukemia (ANL) patients who received BMT before 1980. Group II consisted 39 ALL and 44 ANL patients who were treated after 1981. One-year survivals were 11% and 58% in groups I and II, respectively (p less than 0.001). Probabilities of developing interstitial pneumonia at one year were 93% and 37% in groups I and II, respectively (p less than 0.001). Of 14 patients who developed interstitial pneumonia in group I, twelve (86%) died of interstitial pneumonia. Fifteen of 22 (68%) were fatal in group II. Using proportional hazard regression model, year of BMT (p = 0.0001) and selection of platelet donor with negative cytomegalovirus (CMV) titer (p = 0.0215) were found to be significant risk factors associated with interstitial pneumonia. The present analysis indicated that change in the selection of patients, e.g., in remission without infection at the time of BMT, as well as treatment modality, e.g., fractionated TBI, and selection of platelet donor with negative CMV titer, resulted in the significant improvement in the survival and decreased incidence of interstitial pneumonia.