An Update on Pulmonary Complications of Hematopoietic Stem Cell Transplantation

K., Amy; Soubani, Ayman O.; White, Alexander C.; Miller, Kenneth B.

doi:10.1378/chest.12-1708

Cited by 93 publications

(118 citation statements)

References 77 publications

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“…[52][53][54] Noninfectious causes of organ failure are usually diagnosed after exclusion of infections. They are mainly represented by cardiac edema, treatment toxicity, 39,40,[54][55][56][57][58][59][60][61][62][63] hemorrhages, GvHD, long-term allo-HSCT complications, 60,64 comorbidity decompensation and relapse. Several post-allograft complications can occur, but they do not all occur at any particular stage of the disease.…”

Section: Introductionmentioning

confidence: 99%

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Saillard

Blaise

Mokart

2016

Bone Marrow Transplant

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The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients has significantly improved over the past decade. Still, a significant number of patients require intensive care unit (ICU) management because of life-threatening complications. Literature from the 1990s reported extremely poor prognosis for critically ill allo-HSCT patients requiring ICU management. Recent data justify the use of ICU resources in hematologic patients. Yet, allo-HSCT remains an independent variable associated with mortality. However, outcomes in allo-HSCT patients have improved over time and many classic determinants of mortality have become irrelevant. The main actual prognostic factors are the need for mechanical ventilation, the presence of GvHD and the number of organ failures at ICU admission. Recently, the development of reduced-intensity conditioning regimens, early ICU admission and the increased use of noninvasive ventilation, combined with time effect and general advances in hematology, in allo-HSCT procedures and in ICU management have contributed to improve general outcome. A rational policy of ICU admission triage in these patients is very hard to define, as each decision for ICU admission is a case-by-case decision at patient bedside. The collaboration between hematologists and intensivists is crucial in this context.

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Section: Introductionmentioning

confidence: 99%

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Saillard

Blaise

Mokart

2016

Bone Marrow Transplant

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“…Approximately 20% of patients are asymptomatic, and the diagnosis is suspected based on pulmonary function test findings showing new-onset airflow obstruction. 4 Most patients have a slow progressive airflow obstruction, with episodes of acute exacerbations. In the minority of patients, the airflow obstruction progresses rapidly into respiratory failure within a few months.…”

Section: Bronchiolitis Obliterans Syndromementioning

confidence: 99%

“…4,5 Infectious complications are more common in patients with allogeneic HSCT because of the prolonged immune-suppressive therapy and GVHD.…”

Section: Infectious Complications After Hematopoietic Stem Cell Transmentioning

confidence: 99%

“…However, the incidence of noninfectious complications has not changed, which increases the significance of these conditions. 4,5 Noninfectious pulmonary complications after HSCT range from acute to subacute causes of acute respiratory failure, such as diffuse alveolar hemorrhage and idiopathic pneumonia syndrome, to chronic progressive small airway disease like bronchiolitis obliterans syndrome (BOS), 4 and include vascular complications like pulmonary venoocclusive disease and cytolytic thrombi. Table 1 provides a comparison of the primary noninfectious causes of acute respiratory failure after HSCT.…”

Section: Introductionmentioning

confidence: 99%

“…The median onset time is 11 days, with an incidence of 7% to 11%. [4][5][6] The incidence and severity of this syndrome have increased as a result of use of granulocyte colonystimulating factor, which regulates the production of cytokines (tumor necrosis factor α, interleukin 1B, and interleukin 8). These mediators in turn increase neutrophil influx into the lungs and alveolar permeability and are likely implicated in acute lung injury.…”

Section: Introductionmentioning

confidence: 99%

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Diab

ZazaDitYafawi

Soubani³

2016

Exp Clin Transplant

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Both autologous and allogeneic hematopoietic stem cell transplants are important therapeutic options for several benign and malignant disorders. Pulmonary complications, although they have become less frequent, remain a significant cause of morbidity and mortality after hematopoietic stem cell transplant. These complications range from bacterial, fungal, and viral pulmonary infections to noninfectious conditions such as diffuse alveolar hemorrhage and idiopathic pneumonia syndrome. Bronchiolitis obliterans syndrome is the primary chronic pulmonary complication, and treatment of this condition remains challenging. This report highlights the advances in the diagnosis and management of the major pulmonary complications after hematopoietic stem cell transplant. It also underscores the need for prospective and multicenter research to have a better understanding of the mechanisms behind these complications and to obtain more effective diagnostic tool and therapeutic options. Key words: Adverse effects, Lung diseases/etiology, Lung diseases/diagnosis, Respiratory tract infections/etiology, Graft versus host disease IntroductionHematopoietic stem cell transplant (HSCT) is increasingly being used for treatment of a wide range of benign and malignant diseases. About 50 000 to 60 000 HSCTs are done annually. 1 Hematopoietic stem cell transplant can be classified as autologous when the stem cells are harvested from the same patient and reinfused after high-dose chemotherapy, whereas, in allogeneic HSCT, the stem cells are donated by another person. Allogeneic HSCT can be related or unrelated and matched or mismatched. The hematopoietic stem cells might be derived from the bone marrow, umbilical cord, or peripheral blood.Hematopoietic stem cell transplant can be a lifesaving treatment of a wide range of neoplastic and nonneoplastic diseases; however, it is still limited by the development of serious complications. Advances in the preparative regimen using a nonmyeloablative preparative regimen, reduced-intensity conditioning transplants, and posttransplant supportive care have contributed to improved overall survival. Despite these advances, pulmonary complications still occur in about 37% of patient after HSCT 2 and are associated with significant morbidity and mortality. In 1 study, the hazard ratio for death due to pulmonary complications was 30. 1 However, there is evidence that the overall mortality and pulmonary complications after HSCT are improving. A recent review of allogeneic HSCT patients in a large transplant center from 1993 to 2007 showed that the risk of nonrelapse mortality decreased by 60% and overall mortality decreased by 41%. In addition, the risk of acute respiratory failure dropped by 36%, with risk of gram-negative bacterial and invasive mold infections decreasing by 39% and 51%. 3 In this study, we provide an update of the main pulmonary complications (both infectious and noninfectious) after HSCT, including an overview of the diagnostic approach and treatment of these complications. Noninfec...

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Late non‐infectious pulmonary complications

Soubani

2021

Blood and Marrow Transplantation Long Term Management

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An Update on Pulmonary Complications of Hematopoietic Stem Cell Transplantation

Cited by 93 publications

References 77 publications

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

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Late non‐infectious pulmonary complications

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