Pulmonary Complications After Hematopoietic Stem Cell Transplantation

Lim, Do Hyoung; Lee, Jeeyun; Lee, Hong Ghi; Park, Byeong Bae; Peck, Kyong Ran; Oh, Won Sup; Ji, Sang-Hoon; Lee, Se‐Hoon; Park, Joon Oh; Kım, Kihyun; Kim, Won Seog; Jung, Chul Won; Park, Young Suk; Im, Young Hyuck; Kang, Won Ki; Park, Keunchil

doi:10.3346/jkms.2006.21.3.406

Cited by 31 publications

(26 citation statements)

References 32 publications

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“…Additionally, infections are risk factors for development of some forms of non-infectious lung injury which may occur later, such as IPS (Versluys, 2010). Importantly, infections with bacterial, viral, and fungal pathogens can afflict both allogeneic and autologous HSCT recipients at multiple times post-transplant (Afessa and Peters, 2006; Lim, 2006). …”

Section: Pulmonary Complicationsmentioning

confidence: 99%

Defective Pulmonary Innate Immune Responses Post-Stem Cell Transplantation; Review and Results from One Model System

Domingo-Gonzalez¹,

Moore²

2013

Front. Immunol.

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Infectious pulmonary complications limit the success of hematopoietic stem cell transplantation (HSCT) as a therapy for malignant and non-malignant disorders. Susceptibility to pathogens in both autologous and allogeneic HSCT recipients persists despite successful immune reconstitution. As studying the causal effects of these immune defects in the human population can be limiting, a bone marrow transplant (BMT) mouse model can be used to understand the defect in mounting a productive innate immune response post-transplantation. When syngeneic BMT is performed, this system allows the study of BMT-induced alterations in innate immune cell function that are independent of the confounding effects of immunosuppressive therapy and graft-versus-host disease. Studies from several laboratories, including our own show that pulmonary susceptibility to bacterial infections post-BMT are largely due to alterations in the lung alveolar macrophages. Changes in these cells post-BMT include cytokine and eicosanoid dysregulations, scavenger receptor alterations, changes in micro RNA profiles, and alterations in intracellular signaling molecules that limit bacterial phagocytosis and killing. The changes that occur highlight mechanisms that promote susceptibility to infections commonly afflicting HSCT recipients and provide insight into therapeutic targets that may improve patient outcomes post-HSCT.

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Section: Pulmonary Complicationsmentioning

confidence: 99%

Defective Pulmonary Innate Immune Responses Post-Stem Cell Transplantation; Review and Results from One Model System

Domingo-Gonzalez¹,

Moore²

2013

Front. Immunol.

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“…Pulmonary complications (PCs) are among the most common and lethal complications suffered by hematopoietic SCT (HSCT) patients. [1][2][3][4] The increasing number of indications and the selection of more debilitated patients as potential candidates for HSCT seem to be changing the epidemiology of PC. 5,6 Studies have shown that in immunocompromised patients an early identification of the etiology of PC improves survival.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary complications in hematopoietic SCT: a prospective study

Lucena

Torres

Rovira

et al. 2014

Bone Marrow Transplant

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Pulmonary complications are common and often lethal in hematopoietic SCT recipients. The objective of this prospective interventional study was to evaluate the etiology, diagnostic procedures, risk factors and outcome of pulmonary complications in a cohort of hematopoietic SCT recipients followed up for 1 year. For patients suffering from a pulmonary complication, a diagnostic algorithm that included non-invasive and bronchoscopic procedures was performed. We identified 73 pulmonary complications in 169 patients: 50 (68%) were pneumonias; 21 (29%) were non-infectious complications and 2 (3%) were undiagnosed. Viruses (particularly Rhinovirus) and bacteria (particularly P. aeruginosa) (28 and 26%, respectively) were the most common causes of pneumonia. A specific diagnosis was obtained in 83% of the cases. A non-invasive test gave a specific diagnosis in 59% of the episodes. The diagnostic yield of bronchoscopy was 67 and 78% in pulmonary infections. Early bronchoscopy (⩽5 days) had higher diagnostic yield than late bronchoscopy (78 vs 23%; P = 0.02) for pulmonary infections. Overall mortality was 22 and 32% of all fatalities were due to pulmonary complications. Pulmonary complications are common and constitute an independent risk factor for mortality, stressing the importance of an appropriate clinical management. The increasing number of indications and the selection of more debilitated patients as potential candidates for HSCT seem to be changing the epidemiology of PC. 5,6 Studies have shown that in immunocompromised patients an early identification of the etiology of PC improves survival. 7,8 Fiberoptic bronchoscopy (FOB) has an important role in the diagnosis of PC; 9-12 however, detractors of this technique consider that the information provided may be also obtained by different non-invasive explorations. [13][14][15] The majority of the studies evaluating the etiology, diagnosis and prognosis of PC in patients with hematologic diseases are retrospective, 4,6,16 and include both non-transplantation and transplantation recipients. 2,7 We hypothesized that the prospective follow-up of a cohort of HSCT recipients may improve the clinical management of PC. First, the knowledge of the epidemiology of the PC with the different prevalence of infectious and non-infectious etiologies can be accurately determined. Second, predetermined criteria for performing a FOB should clarify the role of this technique by better defining the diagnostic yield, clinical implications and potential complications. Finally, the identification of prognostic factors is much more precise when data are recorded prospectively in a homogeneous group of immunocompromised patients.The aim of this study was to evaluate the incidence, diagnostic and clinical implications of non-invasive and FOB explorations, risk factors and outcome of PC. To this aim, a cohort of consecutive patients requiring HSCT was followed-up for 1 year and the PC were closely analyzed.

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“…BO and OP as LOPCs occurring more than 3 months after PBSCT are well documented, [1][2][3][4][5][6][7][8][9] whereas NSIP as an LOPC after PBSCT has not been fully investigated. To our knowledge, CT pathologic correlations of NSIP as an LOPC have not been reported.…”

Section: Discussionmentioning

confidence: 98%

“…Interstitial pneumonias as LOPCs after PBSCT are closely related to chronic graft-versus-host disease (GVHD), and they easily develop when chronic GVHD is not well controlled. [1][2][3][4] At the first admission, we reduced the dose of FK 506 because an opportunistic infection was strongly suspected. The dose reduction of FK 506 might have caused cellular NSIP as a chronic GVHD.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] However, various treatment complications after PBSCT have been reported, including late-onset pulmonary complications (LOPCs) occurring more than 3 months after PBSCT. [1][2][3][4][5][6][7][8][9] Bronchiolitis obliterans (BO) and organizing pneumonia (OP) are frequently identified as an LOPC, and BO especially influences the clinical outcome. 8,9 Therefore, it is very important to diagnose these diseases and start treatment early in their course.…”

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confidence: 99%

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Nonspecific Interstitial Pneumonia After Peripheral Blood Stem Cell Transplantation in an 11-year-old boy

Matsumoto

Yabuuchi

Matsuo

et al. 2009

Journal of Thoracic Imaging

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Late-onset pulmonary complications after peripheral blood stem cell transplantation include various conditions such as opportunistic infections and interstitial pneumonias. It is sometimes difficult to diagnose interstitial pneumonias because there is substantial overlap in their computed tomography appearances. We present a case of an 11-year-old boy who consecutively developed pulmonary infection and cellular nonspecific interstitial pneumonia 9 months after peripheral blood stem cell transplantation for recurrent acute lymphocytic leukemia.

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Pulmonary Complications After Hematopoietic Stem Cell Transplantation

Cited by 31 publications

References 32 publications

Defective Pulmonary Innate Immune Responses Post-Stem Cell Transplantation; Review and Results from One Model System

Defective Pulmonary Innate Immune Responses Post-Stem Cell Transplantation; Review and Results from One Model System

Pulmonary complications in hematopoietic SCT: a prospective study

Nonspecific Interstitial Pneumonia After Peripheral Blood Stem Cell Transplantation in an 11-year-old boy

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