Corticosteroids as adjunctive therapy for diffuse alveolar hemorrhage associated with bone marrow transplantation

Metcalf, Jordan P.; Rennard, Stephen I.; Reed, Elizabeth; Haire, William D.; Sisson, Joseph H.; Walter, Trudy; Robbins, Richard

doi:10.1016/0002-9343(94)90062-0

Cited by 115 publications

(70 citation statements)

References 24 publications

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“…40,41 High-dose corticosteroids have been particularly beneficial in patients with diffuse alveolar hemorrhage. 28,42,43 All patients with an ES following our non-myeloablative allogeneic transplant protocol received corticosteroids at a dose of 0.5 to 10 mg/kg per day (median 1 mg/kg per day). 10 All of these patients achieved complete resolution of symptoms and signs of ES, although approximately half of the patients had a recurrence of these symptoms (or development of acute GVHD) during a rapid taper of the corticosteroids in preparation for a 'prophylactic' DLI.…”

Section: Therapy Of Esmentioning

confidence: 99%

Engraftment syndrome following hematopoietic stem cell transplantation

Spitzer

2001

Bone Marrow Transplant

355

386

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Summary:During neutrophil recovery following hematopoietic stem cell transplantation, a constellation of symptoms and signs including fever, erythrodermatous skin rash, and noncardiogenic pulmonary edema often occur. These clinical findings have usually been referred to as engraftment syndrome, or, reflecting the manifestations of increased capillary permeability, capillary leak syndrome. While described most often following autologous stem cell transplantation, a similar clinical syndrome has been observed followed allogeneic stem cell transplantation. Distinction from graft-versus-host disease in the allogeneic setting however, has been difficult. Recent experience with non-myeloablative conditioning for stem cell transplantation, however, reveals that an engraftment syndrome independent of GVHD may occur. In some cases, this engraftment syndrome may be a manifestation of a host-versus-graft reaction (graft rejection). While cellular and cytokine interactions are believed to be responsible for these clinical findings, a distinct effector cell population and cytokine profile have not been defined. Engraftment syndromes are likely associated with an increased transplant-related mortality, mostly from pulmonary and associated multiorgan failure. Corticosteroid therapy is often dramatically effective for engraftment syndrome, particularly for the treatment of the pulmonary manifestations. A proposal for a more uniform definition of engraftment syndrome has been developed in order to allow for a reproducible method of reporting of this complication and for evaluating prophylactic and therapeutic strategies. Bone Marrow Transplantation (2001) 27, 893-898.

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Section: Therapy Of Esmentioning

confidence: 99%

Engraftment syndrome following hematopoietic stem cell transplantation

Spitzer

2001

Bone Marrow Transplant

355

386

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“…DAH develops in 10% to 21% of HSCT recipients. 77,78 Despite the presence of thrombocytopenia in most, DAH is not corrected with platelet transfusions. 77 The pathophysiology of DAH is not clearly understood.…”

Section: Diffuse Alveolar Hemorrhagementioning

confidence: 99%

Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation

Afessa

Tefferi

2001

Bone Marrow Transplant

274

308

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Summary:Pulmonary complications develop in 30-60% of hematopoietic stem cell transplants (HSCT). The main, late onset, non-infectious complications include Bronchiolitis obliterans (BO), Bronchiolitis obliterans organizing pneumonia (BOOP), and idiopathic pneumonia syndrome (IPS). BO and BOOP occur almost exclusively in allogeneic HSCT, and have 61% and 21% mortality rates, respectively. BOOP responds favorably to corticosteroids. IPS has less than 15% 1-year survival. Bone Marrow Transplantation (2001) 28, 425-434. Keywords: pulmonary complications; Bronchiolitis obliterans; Bronchiolitis obliterans organizing pneumonia; interstitial pneumonia; hematopoietic stem cell transplantation Despite the success in treating otherwise fatal diseases, HSCT is associated with multiple complications. Pulmonary complications develop in 30-60% of HSCT recipients. 1,2 Factors that influence the development of pulmonary complications in HSCT include previous infections, pre-transplant conditioning regimen, current or prior immunosuppressant and radiation treatment, type of stem cell transplant (autologous vs allogeneic), use of prophylactic antibiotics, and time elapsed since transplant. With the use of prophylactic antibiotics, the spectrum of pulmonary complications following HSCT has changed increasingly from infectious to non-infectious etiologies. The times of onset and distinguishing features of the main non-infectious pulmonary complications are shown in Figure 1 and Table 1. This review will focus on the late-onset, non-infectious pulmonary complications in HSCT recipients. An algorithmic approach is outlined in Figure 2. Since most of the treatable pulmonary complications in HSCT recipients are diagnosed non-invasively and by bronchoscopy, we rarely subject our patients to surgical lung biopsy. However, in patients with suspected BOOP and when bronchoscopy is contraindicated or non-diagnostic, we occasionally resort to video-assisted thoracoscopic surgical lung biopsy. Abnormal lung functionRestrictive and obstructive ventilatory defects, and gas transfer abnormalities occur frequently in HSCT recipients. 3,4 In a study of 52 young, asymptomatic HSCT recipients, 38% had abnormalities in pulmonary function tests (PFT): 23% restrictive defect with or without impaired gas transfer and 15% isolated impaired gas transfer. 3 An abnormal pulmonary function test is a risk factor for pulmonary complications. 5-9 However, the role of PFT in identifying HSCT recipients at risk for pulmonary complications needs further investigation. The PFT findings in BO, BOOP, and delayed pulmonary toxicity syndrome are listed in Table 2. Bronchiolitis obliterans (BO)GVHD is a frequent complication of allogeneic HSCT. 10 The pulmonary morphological manifestations of GVHD include diffuse alveolar damage, lymphocytic bronchitis/ bronchiolitis with interstitial pneumonitis, BOOP, and BO. 11 BO is a nonspecific inflammatory injury affecting

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“…[11][12][13][14] Diffuse AH (DAH) was initially described in autologous HSCT recipients and since has been described with equal frequency in both allogeneic and autologous transplant recipients. 13,[19][20][21] It is seen in 1-19% of HSCT recipients who undergo bronchoscopy. 3,4,12,[22][23][24] DAH is characterized by the presence of multilobar pulmonary infiltrates and symptoms of pneumonia and hypoxia.…”

Section: Introductionmentioning

confidence: 99%

“…19,[27][28][29] Recent reports have suggested that the administration of recombinant factor VIIa to patients with DAH results in rapid clinical improvement and better survival. 30,31 We also studied the outcomes of patients who received factor VIIa for AH at our center.…”

Section: Introductionmentioning

confidence: 99%