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Prior anti-PD-1 therapy as a risk factor for life-threatening peri-engraftment respiratory distress syndrome in patients undergoing autologous stem cell transplantation

Bone Marrow Transplantation volume 56, pages 1151–1158 (2021)Cite this article

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Abstract

Peri-engraftment respiratory distress syndrome (PERDS) is a kind of potentially life-threatening complication of autologous stem cell transplantation (ASCT). PERDS is characterized by fever, dyspnea, and hypoxemia during neutrophil engraftment. In order to identify the high-risk factors for PERDS, we retrospectively analyzed 260 patients with lymphoma undergoing ASCT in recent five years. The conditioning regimen was BuCyE (busulfan, cyclophosphamide, and etoposide). There were 16 patients (6.1%) diagnosed as PERDS. In multivariate analysis, prior anti-programmed death-1 (PD-1) therapy (hazard ratio [HR] = 8.852, 95% confidence interval [CI]: 2.954–26.527, P < 0.001) and history of pulmonary disease (HR = 3.718, 95% CI: 1.197–11.545, P = 0.023) were independent risk factors for PERDS. Patients with prior anti-PD-1 therapy (n = 31) had higher incidence of engraftment syndrome (77.4% vs. 33.4%, P < 0.001), PERDS (25.8% vs. 3.5%, P < 0.001), and transplant-related mortality (9.7% vs. 0.4%, P < 0.001), compared with those without prior anti-PD-1 therapy (n = 229). Subgroup analysis showed that sintilimab seemed to be associated with higher incidence of PERDS (42.9% vs. 11.8%, P = 0.06) compared with non-sintilimab group (pembrolizumab or toripalimab). C-reactive protein might be a feasible early predictor for PERDS. In conclusion, our study suggests that prior anti-PD-1 therapy may be a strong risk factor for life-threatening PERDS in patients with lymphoma undergoing ASCT.

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Fig. 1: Patients inclusion and classification.

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Acknowledgements

We thank all the patients, their families, and other clinical staff for their participation in the study.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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  1. These authors contributed equally: Bing Bai, Xiao-Xiao Wang, Yan Gao

Authors and Affiliations

  1. Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, China

    Bing Bai, Xiao-Xiao Wang, Yan Gao, Peng-Fei Li, Hai-Xia He, Li-Qin Ping, Cheng Huang & Hui-Qiang Huang

  2. State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, 510060, China

    Bing Bai, Xiao-Xiao Wang, Yan Gao, Peng-Fei Li, Hai-Xia He, Li-Qin Ping, Cheng Huang & Hui-Qiang Huang

  3. Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, China

    Bing Bai, Xiao-Xiao Wang, Yan Gao, Peng-Fei Li, Hai-Xia He, Li-Qin Ping, Cheng Huang & Hui-Qiang Huang

  4. Department of Oncology, Guangdong Clifford Hospital, 3 Hongfu Road, Guangzhou, 511495, China

    Qi-Chun Cai

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Contributions

H-QH, Q-CC and BB designed the research, collected the data, interpreted the data, and wrote the manuscript; X-XW, YG, P-FL, H-XH, CH and L-QP were involved in treating patients, collecting data, and writing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Qi-Chun Cai or Hui-Qiang Huang.

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Bai, B., Wang, XX., Gao, Y. et al. Prior anti-PD-1 therapy as a risk factor for life-threatening peri-engraftment respiratory distress syndrome in patients undergoing autologous stem cell transplantation. Bone Marrow Transplant 56, 1151–1158 (2021). https://doi.org/10.1038/s41409-020-01164-y

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