Idiopathic Pneumonia Syndrome after Bone Marrow Transplantation

102

Summary:idiopathic noninfectious pneumonia; (3) pulmonary edema (hydrostatic or noncardiogenic); (4) respiratory failure (pulmonary and extrapulmonary etiologies); (5) inflammaFiberoptic bronchoscopy (FOB) has been reported to have a high diagnostic yield and to be safe in BMT tory conditions (diffuse alveolar damage (DAD), bronchiolitis obliterans organizing pneumonia (BOOP), bronchiolitis patients with pulmonary infiltrates. At our institution, BMT patients with respiratory symptoms and/or pulobliterans (BO), and pulmonary graft-versus-host disease); (6) pulmonary hemorrhage; and (7) The use of FOB to evaluate pulmonary infiltrates in BMT patients was not previously standardized at our institution. (15%) occurred in 10 FOBs (five acute respiratory failure, three pneumothoraces, one nose bleed, one death).Although the medical literature indicates that FOB in BMT patients with pulmonary infiltrates is a safe and valuable Hospital and 6-month survival based on episodes of clinical pneumonia were 47 and 32%, respectively. diagnostic procedure, its impact on providing a diagnosis, guiding treatment, and patient outcome at our institution Patients who had a diagnostic FOB or a FOB that changed treatment did not have better hospital or 6-was unclear. A data base was established to collect existing clinical information to assess the yield, impact on treatmonth survival compared to patients who had FOBs that were nondiagnostic or did not change treatment.ment, safety and survival in BMT patients who had FOB to evaluate respiratory symptoms and/or pulmonary infiltrates. FOB in our BMT patient population, had a low diagnostic yield (31%), infrequently changed treatment (24%), a significant complication rate (15%) and was not associated with improved patient survival. The role of rouMaterials and methods tine diagnostic FOB in BMT patients with pulmonary infiltrates and/or respiratory symptoms should be rePatient population evaluated.

Section: Complicationsmentioning

confidence: 79%

Section: Complicationsmentioning

confidence: 99%

Utility of fiberoptic bronchoscopy in bone marrow transplant patients

White

Bonacum

Miller

1997

102

“…[25][26][27][28][29] We References do not favor these etiologies for the observed infiltrate for several reasons. Infection is unlikely because sentinel ani-…”

Section: Acknowledgementsmentioning

confidence: 99%

Persistence of pulmonary pathology and abnormal lung function in IL-3/GM-CSF/IL-5 β c receptor-deficient mice despite correction of alveolar proteinosis after BMT

Cooke

Nishinakamura²,

Martin

et al. 1997

Summary:pulmonary alveolar proteinosis (PAP). Abnormalities include lymphocytic infiltration around airways and vessels and the progressive accumulation of surfactant proteins, Mice deficient for the IL-3/GM-CSF/IL-5 ␤c receptor (␤cR KO) develop lung disease similar to that seen in phospholipids and macrophages within the alveolar space. [1][2][3][4][5] Previous work has defined a significant part of this disease human pulmonary alveolar proteinosis (PAP) which includes lymphocytic infiltration around airways and to be hematopoietic in origin because transplantation of wild-type (WT) bone marrow into ␤cR KO mice led to vessels and the progressive accumulation of surfactant and macrophages within the alveolar space. We investicomplete resolution of alveolar proteinosis and restoration of normal macrophage morphology. When the lungs of ␤cR gated bone marrow transplantation (BMT) as a curative treatment of PAP in ␤cR KO mice by semiquantitative KO mice were evaluated at 8 and 12 weeks after WT BMT however, it was apparent that residual lung injury was histologic analysis and evaluation of pulmonary function. BMT from wild-type (WT) donors into lethally present despite the dramatic improvement in the disease state. 6 In order to determine the precise effects of BMT in irradiated ␤cR KO recipients (WT → KO) led to the complete resolution of alveolar protein accumulation the reversal of the mutant phenotype, we examined more closely the extent of residual disease in these animals postand to normalization of BAL fluid cellularity and macrophage morphology. However, detailed microtransplant by using a semiquantitative index for histopathology, and correlated these findings to pulmonary function. scopic analysis of lung tissue revealed the persistence of significant cellular infiltrates in WT → KO recipients Our findings demonstrate that abnormal respiratory physiology and significant mononuclear cell infiltrates remain in which were equivalent to those seen in KO → KO animals. Evaluation of pulmonary function demonstrated ␤cR KO mice despite the marked improvement in alveolar protein accumulation after WT BMT. that only dynamic compliance (C dyn ) and not airway conductance (G L ) was significantly improved in the WT → KO group compared to KO → KO animals and that both of these measurements remained significantly Materials and methods abnormal when compared to WT → WT controls. We conclude, that although BMT for PAP reverses alveolar Mice and bone marrow transplantation macrophage and protein accumulation, it does not decrease the interstitial inflammatory component of this Generation of mice deficient for the ␤c receptor (␤cR KO) and methods for BMT have been described previously. 1,6 disease. The importance of this residual pathology is demonstrated by the incomplete correction of alveolar Briefly, all experimental animals were raised and housed in microisolator cages at the DNAX animal facility and have function (C dyn ) and lack of improvement in increased airway resistance (G L ). These findings may have routinely ...

“…Because their clinical courses were typical for LONIPCs in that they did not fulfill criteria of other lung complications and responded to corticosteroids, we considered it reasonable to include them in the study. On the other hand, although four patients who received allo-HSCT in our institution developed respiratory symptoms within 60 days (days 19, 32, 40 and 48) after allo-HSCT, we excluded them from our study because we had difficulty in distinguishing them from idiopathic pneumonia syndrome 29 or engraftment syndrome. 30 In our study, those patients whose FEV1 decreased at least 20% from the baseline were diagnosed with BO even if FEV1/FVC ratio was over 0.7.…”

Section: Discussionmentioning

confidence: 99%

Outcome and treatment of late-onset noninfectious pulmonary complications after allogeneic haematopoietic SCT

Ueda

Watadani

Maeda

et al. 2010

Late-onset noninfectious pulmonary complications (LONIPCs) are life threatening for allogeneic hematopoietic SCT (allo-HSCT) recipients. However, the impact of LONIPCs on survival has not been properly evaluated and little is known about treatment efficacy. We retrospectively investigated 290 allo-HSCT recipients in our institute and reviewed the clinical aspects of 44 patients who had been diagnosed with LONIPCs. LONIPCs were significantly associated with higher rates of chronic GVHD (Po0001) and nonrelapse mortality (P ¼ 0.013), and lower rates of relapse (P ¼ 0.009). As a result of these effects, OS was significantly worse in those with LONIPCs (P ¼ 0.003). This result differs from a previous report. We then assessed short-term treatment response and final outcome. These results were defined by radiological findings, subjective symptoms, oxygen requirement and survival. Use of inhaled and systemic steroids did not affect either short-term response or final outcomes. However, administration of systemic corticosteroids earlier than at 21 days (median interval of time from onset of symptoms to systemic corticosteroids administration) was associated with a better outcome (P ¼ 0.054 for short-term response, and 0.016 for final outcome). Our study indicates that LONIPCs reduce OS, and early intervention with systemic corticosteroids may be effective.