Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients

Robbins, Richard; Linder, James; Stahl, Marlin G.; Thompson, Austin B.; Haire, William D.; Kessinger, Anne; Armitage, Jamés O.; Arneson, Mark; Woods, Gail L.; Vaughan, William P.; Rennard, Stephen I.

doi:10.1016/s0002-9343(89)80606-0

Cited by 201 publications

(66 citation statements)

References 14 publications

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“…In one small subset of patients with IPS, acute DAH or hemorrhagic alveolitis occurs. DAH generally develops in the immediate post‐SCT period and is characterized by progressive shortness of breath, cough, and hypoxemia with or without fever (7, 13–15). Progressively bloodier aliquots of BAL fluid have traditionally diagnosed DAH, but frank hemoptysis is rare (13).…”

Section: Resultsmentioning

confidence: 99%

Acute lung injury after allogeneic stem cell transplantation: From the clinic, to the bench and back again

Cooke¹

2005

Pediatric Transplantation

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Allogeneic hematopoietic stem cell transplantation (SCT) is the only curative therapeutic option for a number of malignant and non-malignant conditions, but the success of this treatment strategy is limited by several side effects. Diffuse lung injury is a major complication of SCT that responds poorly to standard treatment and significantly contributes to transplant related morbidity and mortality. Lung injury occurs in both acute and chronic forms and can be either infectious or non-infectious in nature. Acute, non-infectious lung injury following SCT has been defined as idiopathic pneumonia syndrome (IPS). This review will outline the clinical spectrum, risk factors, and pathogeneses of IPS and discuss how current approaches to therapy are being influenced by insights generated using animal models of disease.

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Section: Resultsmentioning

confidence: 99%

Acute lung injury after allogeneic stem cell transplantation: From the clinic, to the bench and back again

Cooke¹

2005

Pediatric Transplantation

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“…No compound infectious complication was identified, which might be attributed to prophylactic administration of antimicrobials for HSCT recipients. The detailed pathophysiologies of diffuse alveolar hemorrhage (13-17) and idiopathic pneumonia syndrome (18-21) have not been clarified yet, and the treatment options of these diseases are limited. In general, diffuse alveolar hemorrhage during the pre-engraftment period after HSCT results mainly from idiopathic etiologies and rarely from infections (13-17).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Complications After Hematopoietic Stem Cell Transplantation

Lim

Lee

et al. 2006

J Korean Med Sci

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Despite advanced effective prophylaxes, pulmonary complications still occur in a high proportion of all hematopoietic stem cell recipients, accounting for considerable morbidity and mortality. The aim of our study was to describe the causes, incidences and mortality rates secondary to pulmonary complications and risk factors of such complications following hematopoietic stem cell transplantation (HSCT). We reviewed the medical records of 287 patients who underwent either autologous or allogeneic HSCT for hematologic disorders from February 1996 to October 2003 at Samsung Medical Center (134 autografts, 153 allografts). The timing of pulmonary complications was divided into pre-engraftment, early and late period. The spectrum of pulmonary complications included infectious and non-infectious conditions. 73 of the 287 patients (25.4%) developed pulmonary complications. Among these patients, 40 (54.8%) and 29 (39.7%) had infectious and non-infectious conditions, respectively. The overall mortality rate from pulmonary complications was 28.8%. Allogeneic transplant, grade II-IV acute graft-versus-host disease (GVHD) and extensive chronic GVHD were the risk factors with statistical significance for pulmonary complications after HSCT. The mortality rates from pulmonary complications following HSCT were high, especially those of viral and fungal pneumonia, diffuse alveolar hemorrhage and idiopathic pneumonia syndrome.

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“…The majority of episodes were associated with the acute respiratory distress syndrome requiring mechanical ventilatory support. The lung injury was characterized by intraalveolar hemorrhage with diffuse alveolar damage and organizing pneumonia due in part to GVHD-related immunologic mechanisms and the direct and indirect effects of infection (36, 37). As such, anti-inflammatory and antimicrobial therapies were the cornerstones of therapy.…”

Section: Discussionmentioning

confidence: 99%

Recombinant Human Factor VIIa for Alveolar Hemorrhage Following Allogeneic Stem Cell Transplantation

Elinoff

Bağcı

Moriyama

et al. 2014

Biology of Blood and Marrow Transplantation

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The mortality rate of alveolar hemorrhage following allogeneic hematopoietic stem cell transplantation is greater than 60% with supportive care and high dose steroids. We performed a retrospective cohort analysis to assess the benefits and risks of rFVIIa as a therapeutic adjunct for alveolar hemorrhage. From 2005 to 2012, 57 episodes of alveolar hemorrhage occurred in 37 patients. Fourteen episodes (in 14 patients) were treated with steroids alone and 43 episodes (in 23 patients) were treated with steroids and rFVIIa. The median (interquartile range) steroid dose was 1.9 mg/kg/d (0.8 – 3.5; methylprednisolone equivalents) and did not differ statistically between the two groups. The median rFVIIa dose was 41 μg/kg (39-62) and a median of 3 doses (2-17) was administered per episode. Concurrent infection was diagnosed in 65% of the episodes. Patients had moderately severe hypoxia (median PaO2/FiO2, 193 [141-262]); 72% required mechanical ventilation and 42% survived to extubation. The addition of rFVIIa did not alter time to resolution of alveolar hemorrhage (p = 0.50), duration of mechanical ventilation (p = 0.89), duration of oxygen supplementation (p = 0.55), or hospital mortality (p = 0.27). Four possible thrombotic events (9% of 43 episodes) occurred with rFVIIa. rFVIIa when used in combination with corticosteroids did not confer clear clinical advantages compared to corticosteroids alone. In patients with AH following hematopoietic stem cell transplant, clinical factors (i.e. worsening infection, multiple organ failure or recrudescence of primary disease) may be more important than the benefit of enhanced hemostasis from rFVIIa.

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Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients

Cited by 201 publications

References 14 publications

Acute lung injury after allogeneic stem cell transplantation: From the clinic, to the bench and back again

Acute lung injury after allogeneic stem cell transplantation: From the clinic, to the bench and back again

Pulmonary Complications After Hematopoietic Stem Cell Transplantation

Recombinant Human Factor VIIa for Alveolar Hemorrhage Following Allogeneic Stem Cell Transplantation

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