Continuous Veno-Venous Hemofiltration May Improve Survival From Acute Respiratory Distress Syndrome After Bone Marrow Transplantation or Chemotherapy

DiCarlo, Joseph; Alexander, Steven R.; Agarwal, Rajni; Schiffman, Joshua D.

doi:10.1097/00043426-200310000-00012

Cited by 103 publications

(60 citation statements)

References 33 publications

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“…3,4,6,8 Moreover, high-dose corticosteroid therapy (Ͼ 2 mg/kg per day of methylprednisolone equivalent) has not been shown to improve outcome compared with lower doses of corticosteroids (Յ 2 mg/kg per day). 6 Implementation of advanced supportive care measures, including the use of continuous veno-venous hemofiltration, may help to improve survival in some selected patients, 48 but prospective studies are lacking in the literature. The current study confirms and extends results from our initial case series in patients with IPS 5 and shows that the combination of etanercept plus corticosteroids is associated with favorable outcomes, with CRs noted in 67% of patients.…”

Section: Org Frommentioning

confidence: 99%

The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation

Yanik

Levine

et al. 2008

Blood

121

109

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Idiopathic pneumonia syndrome (IPS) refers to a diffuse, noninfectious, acute lung injury after hematopoietic stem cell transplantation. Historically, IPS is associated with respiratory failure and mortality rates exceeding 50%. Preclinical studies have implicated tumor necrosis factor-␣ as an important effector molecule in the development of disease. We studied the tumor necrosis factor-␣ inhibitor, etanercept, combined with corticosteroids in treating 15 patients (median age, 18 years; range, 1-60 years) with IPS. Eight of 15 patients required mechanical ventilation at therapy onset. Etanercept was administered subcutaneously at a dose of 0.4 mg/kg (maximum 25 mg) twice weekly, for a maximum of 8 doses. Therapy was well tolerated with no infectious pulmonary complications noted. Ten of 15 patients had a complete response, defined as the ability to discontinue supplemental oxygen support during study therapy. The median time to complete response was 7 days (range, 3-18 days), with a day 28 survival of 73%. IPS onset was associated with elevations of several inflammatory proteins in the bronchoalveolar lavage fluid and plasma, and response to therapy correlated with reductions in pulmonary and systemic inflammation. The combination of etanercept and corticosteroids is safe and is associated with high response rates and improved survival in patients with IPS. IntroductionNoninfectious lung injury is a frequent and severe complication of hematopoietic stem cell transplantation (HCT) both in the immediate posttransplantation period and in the months and years that follow. In the acute setting, a diffuse interstitial process, termed idiopathic pneumonia syndrome (IPS), may develop. [1][2][3] In 1993, a panel convened by the National Institutes of Health (NIH) proposed a broad working definition of IPS to include widespread alveolar injury in the absence of active lower respiratory tract infection after HCT. 1 The NIH panel stressed that they considered this definition to be that of a clinical syndrome, with variable histopathologic correlates and several potential etiologies. Diagnostic criteria of IPS include signs and symptoms of pneumonia, nonlobar radiographic infiltrates, abnormal pulmonary function, and the absence of infectious organisms in the lower respiratory tract. 1 Published reports indicate that IPS develops in 7% to 15% of allogeneic HCT patients, a median of 14 to 42 days after transplantation. Survival after onset is poor, with mortality rates of 50% to 80% reported. 1,[4][5][6] The typical clinical course involves a rapid onset of respiratory failure leading to death, underscoring the critical nature of this transplantation-related complication. 4 Potential etiologies for IPS include direct toxic effects of HCT conditioning regimens, the presence of occult pulmonary infections, and damage from inflammatory cytokines that have been implicated in other forms of pulmonary injury. 1,2,6-8 Although IPS has been reported after autologous HCT, it is primarily a complication of allogeneic transplantations...

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Section: Org Frommentioning

confidence: 99%

The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation

Yanik

Levine

et al. 2008

Blood

121

109

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“…In this trial, only 4 of the 10 children had AKI, but all underwent early continuous venovenous hemodiafiltration to achieve a negative or zero fluid balance. Ninety percent of the subjects achieved resolution of their ARDS, with 8 of the 10 patients alive at the 18-mo follow-up (87). On the other hand, Hoste et al (84) conducted a retrospective study of 37 patients with AKI and ALI, all of whom underwent continuous venovenous hemodiafiltration.…”

Section: Effects Of Fluid Management and Renal Replacement Therapy Onmentioning

confidence: 99%

Mechanical Ventilation and Lung–Kidney Interactions

Koyner

Murray

2008

Clinical Journal of the American Society of Nephrology

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“…7 Advances in supportive care including the early institution of continuous veno-venous hemofiltration may help to improve survival in some patients. 115 However, prospective studies addressing the treatment of IPS, including the specific use of steroids, are lacking in the literature and no agent or combination of agents has been proven superior. In light of the poor response rate to standard treatment, the lack of prospective treatment trials and preclinical and clinical data that suggest a potential role for TNFa in the development of noninfectious lung injury after SCT, etanercept (Enbrel, Amgen Corp., Thousand Oaks, CA, USA) was administered to three consecutive pediatric patients at the University of Michigan SCT program who met criteria for IPS.…”

Section: Treatment Strategies For Ips After Allogeneic Sctmentioning

confidence: 99%

Acute lung injury after allogeneic stem cell transplantation: is the lung a target of acute graft-versus-host disease?

Cooke

Yanik

2004

Bone Marrow Transplant

103

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Summary:Allogeneic hematopoietic stem cell transplantation (SCT) is an important therapeutic option for a number of malignant and nonmalignant conditions but the broader application of this treatment strategy is limited by several side effects. In particular, diffuse lung injury is a major complication of SCT that responds poorly to standard therapeutic approaches and significantly contributes to transplant-related morbidity and mortality. Historically, approximately 50% of all pneumonias seen after SCT have been secondary to infection, but the judicious use of broad-spectrum antimicrobial prophylaxis in recent years has tipped the balance of pulmonary complications from infectious to noninfectious causes. This mini review will discuss the definition, risk factors and pathogeneses of noninfectious lung injury that occurs early after allogeneic SCT.

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Continuous Veno-Venous Hemofiltration May Improve Survival From Acute Respiratory Distress Syndrome After Bone Marrow Transplantation or Chemotherapy

Cited by 103 publications

References 33 publications

The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation

The impact of soluble tumor necrosis factor receptor etanercept on the treatment of idiopathic pneumonia syndrome after allogeneic hematopoietic stem cell transplantation

Mechanical Ventilation and Lung–Kidney Interactions

Acute lung injury after allogeneic stem cell transplantation: is the lung a target of acute graft-versus-host disease?

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