Interstitial Pneumonia and Cytomegalovirus Infection as Complications of Human Marrow Transplantation1

Mediastinal emphysema and bilateral pneumothoraces with chronic GVHD in patients after allogeneic stem cell transplantation

“…[30][31][32] In recent years, cases of late-onset lung complications associated with chronic GVHD have been reported. [6][7][8][9][10][11][12][13][14][15] The first detailed report of IP after BMT was a report by Neiman et al in 1973, 6 and an association between IP and allogeneic marrow grafts and GVHD was noted. On the other hand, ME and BP after allo-SCT are rare complications, [16][17][18][19][20][21][22][23][24][25][26] and ME and BP with chronic GVHD after allo-SCT are extremely rare, [19][20][21][24][25][26] only seven cases having been reported.…”

“…4 Infectious and noninfectious lung complications occur during both the early and late phases of the post transplantation period. Bacterial, fungal, and viral infections are mostly seen in the early phase after allo-SCT, 5 and CMV infection [1][2][3][4][5] and lung complications associated with graft-versus-host disease (GVHD) [6][7][8] are frequently seen in the late phase.…”

Acute lung injury after allogeneic stem cell transplantation: is the lung a target of acute graft-versus-host disease?

“…8 Mortality rates ranged from 60 to 80% overall, and were greater than 95% for patients requiring mechanical ventilation. 1,3,[5][6][7][8]11 A retrospective study from Seattle showed a lower incidence and earlier onset of IPS than previously reported, but the typical clinical course involving the rapid onset of respiratory failure leading to death remained unchanged. 6 A recent review from the University of Michigan Medical Center demonstrated that the frequency of IPS after allogeneic SCT ranged from 5 to 25% depending upon the donor source and the degree of antigenic mismatch between donor and recipient.…”

“…[31][32][33][34][35] Other immunologic factors may also be important as suggested by the association of Table 4 Risk factors for idiopathic pneumonia syndrome GVHD prophylaxis (methotrexate) 3 Acute GVHD (grades II-IV) 2,25 Acute GVHD (grade IV) 3,6 Increasing recipient age (X21 years) 3,25 (440 years) 28 Total body irradiation (TBI) X1200 cGy 2,3,28 ; dose rate of TBI (X6 Cgy/min) 3 Myeloablative conditioning High-dose 1-3 bis chloroethyl-1 nitrosurea 25 Decreased pre-transplant performance status 3 Longer duration from diagnosis to transplant 3 Transplantation for malignancy other than leukemia 6 Transplantation for hematologic malignancy 9 HLA disparity (donor:recipient) 12 IPS and severe GVHD in several large series. 2,3,[5][6][7]11 Moreover acute GVHD often precedes IPS, suggesting a possible causal relationship between the two disorders. 5,9,36,37 Although the lung is not recognized as a classic target organ of GVHD, the clinical association between lung injury and GVHD, along with the demonstration of pathologic lung changes in rodents with acute GVHD, make this possibility intriguing.…”

Non-infectious lung complications are closely associated with chronic graft-versus-host disease: a single center study of incidence, risk factors and outcome

“…[5][6][7][8][9][10][11][12] The terms late-onset pulmonary syndrome or late-onset-noninfectious pulmonary complications have been used alternatively to describe those NILC occurring later than 3 or 6 months after BMT or PBSCT. 13,14 The pathogenesis of NILC is unclear at present.…”