Background/Objectives: Smoking is linked to an increased risk of pulmonary complications and adverse outcomes following allogeneic hematopoietic cell transplantation (Allo-HCT). Unfortunately, data is rarely correlated with the incidence of GVHD and does not show whether smoking has a negative impact independent from underlying pulmonary comorbidities. Methods: We retrospectively analyzed 407 patients who underwent Allo-HCT between January 2019 and May 2021 and evaluated the impact of smoking history and pre-transplant pulmonary comorbidities on the risk of outcomes including graft-versus-host disease (GVHD), overall survival (OS), and non-relapse mortality (NRM). Results: Patients were divided into the following groups: Group A: smokers with pre-transplant pulmonary comorbidity, 40 pts (9.8%); Group B: non-smokers with pre-transplant pulmonary comorbidity, 71 pts (17.4%); Group C: smokers without pre-transplant pulmonary comorbidity, 105 pts (25.8%); and Group D: non-smokers without pre-transplant pulmonary comorbidity, 191 pts (46.9%). Smokers were also grouped by their smoking history (<10 pack-years (59 pts), 11 to 25 pack-years (50 pts), and >25 pack-years (35 pts)) and by smoking recency: Recent (until Allo-HCT), Former (quit > 1 year ago), and Remote smokers (quit > 10 years ago). Our results showed that Group A demonstrated increased chronic lung GVHD compared to the other groups (p= 0.01). The 3-year OS was lowest in Group A at 45.0%, compared to 70.4%, 62.4%, and 69.4% (p= 0.006), and the NRM was highest at 37.5%, compared to 15.5%, 18.2%, and 14.7% in Groups B, C, and D, respectively (p= 0.001). Smoking recency and higher pack-year dose were associated with worse outcomes. Conclusions: Our study demonstrated the negative synergistic effect of smoking history and pre-transplant pulmonary comorbidities on the incidence of lung GVHD, OS, and NRM.
背景/目的：吸烟与异基因造血细胞移植后肺部并发症风险增加及不良结局相关。遗憾的是，现有数据很少与移植物抗宿主病发生率相关联，且未能明确吸烟的不良影响是否独立于既存肺部合并症存在。方法：我们回顾性分析了2019年1月至2021年5月期间接受异基因造血细胞移植的407例患者，评估吸烟史及移植前肺部合并史对移植物抗宿主病、总生存期和非复发死亡率等结局风险的影响。结果：患者被分为以下四组：A组：有吸烟史且伴有移植前肺部合并症，40例（9.8%）；B组：无吸烟史但伴有移植前肺部合并症，71例（17.4%）；C组：有吸烟史但不伴有移植前肺部合并症，105例（25.8%）；D组：无吸烟史且不伴有移植前肺部合并症，191例（46.9%）。根据吸烟史程度将吸烟者分为三组：<10包·年（59例）、11-25包·年（50例）和>25包·年（35例）；按吸烟近况分为：近期吸烟者（持续至移植前）、既往吸烟者（戒烟>1年）和远期吸烟者（戒烟>10年）。结果显示，与其他组相比，A组慢性肺移植物抗宿主病发生率更高（p=0.01）。A组3年总生存率最低（45.0%），而B、C、D组分别为70.4%、62.4%和69.4%（p=0.006）；A组非复发死亡率最高（37.5%），B、C、D组分别为15.5%、18.2%和14.7%（p=0.001）。近期吸烟及更高包·年累积量与更差的临床结局相关。结论：本研究证实了吸烟史与移植前肺部合并症对肺移植物抗宿主病发生率、总生存期和非复发死亡率存在协同负向影响。
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