Noninfectious lung complications of hematopoietic cell transplantation

Williams, Kirsten M.

doi:10.1182/hematology.2021000293

Cited by 7 publications

(2 citation statements)

References 90 publications

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“…Often there may be infectious aetiologies co-existing with noninfective complications or be contributing to the immune dysregulation and frequently irreversible lung injury seen in diffuse alveolar haemorrhage (DAH), cryptogenic organizing pneumonia (COP) and BO. It is beyond the scope of this review to describe all noninfective post HSCT pulmonary diseases, and several authors have expertly summarized [1 ▪▪ ,9,34 ▪▪ ] the most common conditions including their clinical presentation, imaging findings, treatments and potential new therapies and future research targets. Better understanding of the pathophysiology and biological factors driving these conditions is required due to their high mortality.…”

Section: Noninfective Post Paediatric Haematopoietic Stem Cell Transp...mentioning

confidence: 99%

Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient

Walker

Shanthikumar

Cole

et al. 2022

Current Opinion in Infectious Diseases

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Purpose of reviewHaematopoietic stem cell transplant (HSCT) remains the only curative treatment option for many children with relapsed leukaemia, primary immunodeficiencies and haemoglobinopathies. Unfortunately, infectious and noninfectious pulmonary complications following HSCT continue to cause significant morbidity and mortality. This review will focus on recent advances in the field that enhance clinically available diagnostic tools and the role of novel diagnostic techniques.Recent findingsResearch continues to highlight the role of standard diagnostic modalities, including imaging using computed topography chest and Fluorodeoxyglucose-positron emission tomography (FDG-PET) in the diagnosis of posttransplant pulmonary infections. Similarly, bronchoalveolar lavage using bronchoscopy to obtain samples for microbiological analysis remains an important tool in the clinical and diagnostic algorithm for these children. The application of more novel diagnostic techniques such as metagenomic next-generation sequencing and the use of specific biomarkers remain potential future tools in children in whom the aetiology of posttransplant lung disease is unknown. The impact of the pulmonary microbiome on infectious and noninfectious pulmonary disease post HSCT is a future research direction.SummaryPulmonary infectious complications post HSCT remain a devastating complication for children and their families. Despite improvements in standard and novel diagnostic modalities, the aetiology of pulmonary disease remains unknown for many patients. There is an urgent need for ongoing collaborative research to bridge this critical knowledge gap and lead to better patient outcomes.

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Section: Noninfective Post Paediatric Haematopoietic Stem Cell Transp...mentioning

confidence: 99%

Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient

Walker

Shanthikumar

Cole

et al. 2022

Current Opinion in Infectious Diseases

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“…The pathophysiology of DAH is poorly understood but hypothesized to involve injury to the pulmonary endothelium from preparative agents, inflammation, and cytokine release ( 4 , 5 ). There are no standard therapies for DAH ( 6 ). Historically, treatment included high-dose corticosteroids ( 3 , 7 , 8 ), though recent reports suggest this approach is associated with poorer survival after HCT ( 9 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality

Schoettler,

Dandoy,

Harris

et al. 2023

Front. Oncol.

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Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of hematopoietic cellular therapy (HCT). This study aimed to evaluate the effect of DAH treatments on outcomes using data from consecutive HCT patients clinically diagnosed with DAH from 3 institutions between January 2018-August 2022. Endpoints included sustained complete response (sCR) defined as bleeding cessation without recurrent bleeding, and non-relapse mortality (NRM). Forty children developed DAH at a median of 56.5 days post-HCT (range 1-760). Thirty-five (88%) had at least one concurrent endothelial disorder, including transplant-associated thrombotic microangiopathy (n=30), sinusoidal obstructive syndrome (n=19), or acute graft versus host disease (n=10). Fifty percent had a concurrent pulmonary infection at the time of DAH. Common treatments included steroids (n=17, 25% sCR), inhaled tranexamic acid (INH TXA,n=26, 48% sCR), and inhaled recombinant activated factor VII (INH fVIIa, n=10, 73% sCR). NRM was 56% 100 days after first pulmonary bleed and 70% at 1 year. Steroid treatment was associated with increased risk of NRM (HR 2.25 95% CI 1.07-4.71, p=0.03), while treatment with INH TXA (HR 0.43, 95% CI 0.19- 0.96, p=0.04) and INH fVIIa (HR 0.22, 95% CI 0.07-0.62, p=0.005) were associated with decreased risk of NRM. Prospective studies are warranted to validate these findings.

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Clinical impact of airflow obstruction after allogeneic hematopoietic stem cell transplantation

Nakao,

Tsukamoto,

Takeda

et al. 2024

Int J Hematol

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Criteria for airflow obstruction (AFO) at one year after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in pulmonary function tests (PFTs) are more stringent than the bronchiolitis obliterans syndrome (BOS) criteria of the National Institutes of Health. This single-center, retrospective cohort study evaluated the clinical impact of the AFO criteria at any time after transplantation. In 132 patients who underwent allo-HSCT from 2006 to 2016, the 2-year cumulative incidence of AFO was 35.0%, and the median time to diagnosis of AFO was 101 days after transplantation (range 35–716 days). Overall chronic graft-versus-host disease (cGVHD) incidence was significantly higher in patients with AFO than in those without AFO (80.4% vs. 47.7%, P < 0.01); notably, 37.0% of patients with AFO developed cGVHD after AFO diagnosis. AFO patients developed BOS with a 5-year cumulative incidence of 49.1% after AFO onset. The 5-year cumulative incidence of non-relapse mortality in the AFO group was higher than that in the non-AFO group (24.7% vs. 7.1%, P < 0.01). These results suggest that closely monitoring PFTs within two years after allo-HSCT, regardless of cGVHD status, is important for early detection of AFO and prevention of progression to BOS. (192words).

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Noninfectious lung complications of hematopoietic cell transplantation

Cited by 7 publications

References 90 publications

Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient

Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient

Diffuse alveolar hemorrhage after hematopoietic cell transplantation- response to treatments and risk factors for mortality

Clinical impact of airflow obstruction after allogeneic hematopoietic stem cell transplantation

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