Increasing incidence of diffuse alveolar hemorrhage following allogeneic bone marrow transplantation: cryptic etiology and uncertain therapy

Abstract

Summary:Diffuse alveolar hemorrhage (DAH) is a non-infectious pulmonary complication of bone marrow transplantation (BMT) with resultant high mortality. It reportedly occurs primarily in autologous recipients. We examined the incidence of DAH in our center in order to assess potential risk factors and develop pre- No recognizable alteration in supportive care, conditioning regimen, GVHD prophylaxis or cytokine usage was associated with this striking increase in the frequency of DAH after allografting. Further follow-up is required to establish whether this increase in the incidence of DAH in allogeneic transplantation is an isolated occurrence or an ongoing problem. If indeed there is a real increase in the incidence of this complication, then efforts need to be directed towards elucidating a possible cause or risk factors. We offer the possibility that a new unidentified infection, undetected by current microbiological tests might contribute to this striking increase in DAH. These data, while not establishing a cause, suggest a markedly augmented risk of DAH in allogeneic BMT. In addition, high-dose corticosteroids have only limited efficacy as therapy for DAH after allotransplantation. Further investigation into the pathogenesis of this syndrome is essential as is prompt and immediate consideration of DAH in all patients with respiratory compromise early after BMT. Bone Marrow Transplantation (2000) 26, 539-543.

Diffuse Alveolar Hemorrhage in Acute Myeloid Leukemia

“…7 Infections, transplantation, including HSCT, and radiotherapy have all been associated with this pattern of DAH. 7 …”

“…The most common presentation described is associated with pulmonary vasculitis or capillaritis and involves neutrophilic infiltration and destruction of the pulmonary interstitium. 2,7 This pattern of DAH is often caused by systemic autoimmune vasculitides. Another characteristic pattern involves extravasation of red blood cells into the alveoli without signs of vasculitis or inflammation, and it may be seen with infections and a variety of drugs, including anticoagulants.…”

“…Another characteristic pattern involves extravasation of red blood cells into the alveoli without signs of vasculitis or inflammation, and it may be seen with infections and a variety of drugs, including anticoagulants. 2,7 Diffuse alveolar damage with edema of the alveolar septa without signs of lung inflammation or direct extravasation of red blood cells characterizes a third pattern of DAH, with hyaline membranes forming along the alveolar spaces. 7 Infections, transplantation, including HSCT, and radiotherapy have all been associated with this pattern of DAH.…”

“…2,7 Diffuse alveolar damage with edema of the alveolar septa without signs of lung inflammation or direct extravasation of red blood cells characterizes a third pattern of DAH, with hyaline membranes forming along the alveolar spaces. 7 Infections, transplantation, including HSCT, and radiotherapy have all been associated with this pattern of DAH. 7 …”

“…2 Although DAH is a clinical syndrome drawing together clinical symptoms, laboratory abnormalities, and find- ings on imaging, bronchoscopy with BAL showing progressively bloody effluent is usually diagnostic. 7 When it is performed, Prussian blue staining of the BAL fluid will characteristically reveal hemosiderin-laden macrophages or siderophages. 3 Prussian blue staining was not performed in our case series.…”