Early Onset Noninfectious Pulmonary Syndromes after Hematopoietic Cell Transplantation

Abstract

This article reviews the noninfectious pulmonary syndromes that cause morbidity and mortality early after hematopoietic cell transplantation with an emphasis on risk factors, clinical manifestations, treatment, and outcomes. The first section covers idiopathic pneumonia syndrome and its subtypes: peri-engraftment respiratory distress syndrome, diffuse alveolar hemorrhage, delayed pulmonary toxicity syndrome, and cryptogenic organizing pneumonia. The second section covers pulmonary toxicities of chemotherapies and immunosuppressive agents used in this setting. The final section covers less common syndromes, including pulmonary alveolar proteinosis, venous thromboembolism, pulmonary cytolytic thrombi, pulmonary venoocclusive disease, and transfusion-related acute lung injury.

Acute Complications in Stem Cell Transplantation

“…The usual presentation occurs before 120 days, most commonly between day+18 and day+21. This is, in contrast, to the commonly noticed risk period of day+40 to +50, approximately two decades back (Vande Vusse and Madtes 2017 ). In contrast, IPS in autologous HCT usually presents around day+63 (range: 7–336 days) (Cheng and Madtes 2017 ).…”

“… Macrolides : When used at doses higher than used for infections, it suppresses macrophage-derived cytokines. It has been shown to improve cryptogenic organizing pneumonia in small studies, however, outside transplant setting (Vande Vusse and Madtes 2017 ). …”

Lung histopathology of non‐infectious pulmonary complications after allogeneic haematopoietic stem cell transplantation

“…Non‐infectious pulmonary complications (NIPCs) occurring after allogeneic haematopoietic stem cell transplant (HSCT) are usually classified according to their delay after transplantation. Early complications, including idiopathic pneumonia syndrome, occur in the weeks following the transplant, whereas late complications occur after the third month post‐transplant . The benefit–risk ratio of a surgical lung biopsy (SLB) for diagnosing these NIPCs is not well established …”

Engraftment syndrome following hematopoietic stem cell transplant: A review of the literature

“…Additionally, there is a complex interplay of differential diagnosis, including PERDS and hyperacute GVHD, which have similar timing, symptoms and pathophysiology. The distinction of these from ES is unclear and may manifest from ES, overlap or occur in isolation 11,20,21 . This literature review gathered information from an extensive list of original studies to explore and collate current knowledge to seek consensus or overall best practice recommendations relating to treatment and diagnosis of ES.…”

“…Peri‐engraftment respiratory distress syndrome (PERDS) is an emerging term within the literature and may be discussed in connection to ES. However, the link between the two syndromes remains elusive with PERDS potentially being a respiratory manifestation of ES or they may be two distinct entities 19‐22 . PERDS will not be discussed in this paper.…”