Pulmonary Complications in Hematopoietic Stem Cell Transplant Recipients—A Clinician Primer

Astashchanka, Anna; Ryan, Joseph M.; Lin, Erica; Nokes, Brandon; Kligerman, Seth; Malhotra, Atul; Mandel, Jess; Joshua, Jisha

doi:10.3390/jcm10153227

Cited by 24 publications

(11 citation statements)

References 146 publications

(248 reference statements)

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“…PVOD in the context of MM, can develop in patients treated with alkylating agents such as cyclophosphamide and as a complication of hematopoietic stem cell transplant, usually has a poor prognosis. 13 , 55 , 56 …”

Section: Etiology and Pathophysiology Of Ph‐mmmentioning

confidence: 99%

“…Features such as severely reduced diffusion capacity on PFTs, and presence of subpleural thickened septal lines, centrilobular ground‐glass opacities, and mediastinal lymphadenopathy on high resolution CT scan of chest will favor a diagnosis of PVOD. PVOD in the context of MM, can develop in patients treated with alkylating agents such as cyclophosphamide and as a complication of hematopoietic stem cell transplant, usually has a poor prognosis 13,55,56 …”

Section: Etiology and Pathophysiology Of Ph‐mmmentioning

confidence: 99%

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Pulmonary hypertension in patients with multiple myeloma: A comprehensive review

et al. 2023

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Multiple myeloma (MM) is a common hematological malignancy resulting from clonal proliferation of plasma cells and is defined by criteria set forth by the international myeloma working group. Pulmonary hypertension (PH) is defined by an elevated mean pulmonary artery pressure >20 mmHg measured during right heart catheterization. Echocardiography‐diagnosed PH is relatively common in patients with MM and has been associated with increased mortality, morbidity, and poor stem cell transplant outcomes. PH in patients with MM (PH‐MM) is usually multifactorial in origin. MM disease‐specific factors, host comorbidities, and treatment‐related adverse effects are the key factors for the development of PH‐MM. Pragmatically, patients with PH‐MM can be grouped into either (i) PH in patients with a new diagnosis of MM or (ii) PH that develops or worsens along the way of MM treatment. In the latter group, drug‐induced PH, venous thromboembolism, pulmonary veno occlusive disease, and cardiotoxicity should be considered as possible causes. PH‐MM should be evaluated and managed in a multidisciplinary setting. Select individuals with PH‐MM could be considered for pulmonary vasodilators at PH‐specialized centers.

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Section: Etiology and Pathophysiology Of Ph‐mmmentioning

confidence: 99%

Section: Etiology and Pathophysiology Of Ph‐mmmentioning

confidence: 99%

Pulmonary hypertension in patients with multiple myeloma: A comprehensive review

et al. 2023

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“…[1][2][3] Therapies for these complications vary widely and the diagnosis of noninfectious complications frequently depends upon excluding infection. 4,5 Therefore, the infectious diagnostic approach is of utmost importance. Infection identification is important for targeted antimicrobial therapy, antimicrobial stewardship, and appropriateness of other therapeutic options.…”

Section: Introductionmentioning

confidence: 99%

“…Children with leukemia or who have recently received hematopoietic stem cell transplantation (HSCT) are at risk for infectious and noninfectious pulmonary complications 1–3 . Therapies for these complications vary widely and the diagnosis of noninfectious complications frequently depends upon excluding infection 4,5 . Therefore, the infectious diagnostic approach is of utmost importance.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield of bronchoscopy in children with leukemia or post hematopoietic stem cell transplant

Georgescu,

Rahrig,

Montgomery

et al. 2023

Pediatric Pulmonology

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BackgroundThe utility of bronchoscopy with bronchoalveolar lavage (BAL) in immunocompromised children is not well understood. We aim to describe the bronchoscopy diagnostic yield and complications and to investigate factors associated with diagnostic yield.MethodsThis is a single‐center, retrospective cohort study of 60 children with leukemia or post‐hematopoietic stem cell transplant who had a bronchoscopy with BAL between 2017 and 2021. Comparisons were done with regression analysis.ResultsOf the 60 bronchoscopies performed, 46 (77%) revealed diagnostic information: 39 (65%) identified a pathogen, 14 (23.3%) found secretions/mucus plugging, and 6 (10%) found pulmonary hemorrhage. BAL results changed antimicrobial therapy in 27 (45%) cases. Bronchoscopies were performed in the intensive care unit (27/60) or operating room (33/60), with the former having a higher diagnostic yield (96% vs. 60%, p = 0.001). Half (50%) of bronchoscopies found a new infectious diagnosis. Respiratory symptoms (n = 58, 97%), supplemental oxygen use (n = 39, 65%), and antibiotic use (n = 56, 93%) before bronchoscopy were all common. The median volume of fluid instilled during bronchoscopy was 1.3 mL/kg (interquatile range [IQR]: 0.7, 2.6). None of these factors were associated with the diagnostic yield. Complications were rare and minor with only one child having self‐resolved bleeding and four children, previously in room air requiring a nasal cannula. For the 27 (45%) children on mechanical ventilation when the bronchoscopy was performed, there was no difference in ventilator settings pre‐ and post‐bronchoscopy.ConclusionBronchoscopies with BAL are useful, safe, and important in the diagnostic management of pulmonary complications in this cohort of children.

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“…In the patients undergoing HSCT, severe impairement of lung microbiota is observed, due to transient cytopenia, immunocompromised state and massive antibiotic prophylaxis at early terms posttransplant. Early and late pulmonary infections post-HSCT are well known and described in details as reviewed by Astaschanka et al [7].…”

Section: Introductionmentioning

confidence: 99%

Spectrum of bronchoalveolar bacterial microbiota following hematopoietic stem cell transplantation: age dependence and microbiota shifts

Spiridonova¹,

Волкова²,

Чухловин³

et al. 2022

CTT

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3-4 months posttransplant, due to selection of antibiotic-resistant strains. ConclusionThe patients with oncohematological disease subjected to massive allogeneic HSCT exhibit sufficient changes of bronchoalveolar microbiota over first 6 months posttransplant. Decreased seeding levels are shown for S.viridans and S.epidermidis in adolescents over 15 years and adults. A sufficient suppression of BAL microbiota is revealed within 1 st month posttransplant. At later terms after HSCT, high risk of Klebsiella spp. coloniza-tion is observed, due to selection of antibiotic-resistant strains. Higher incidence of K.pneumoniae and its high resistance rates suggest relevance of this pathogen for development of nosocomial infections in immunocompromised patients and other clinical settings.

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Pulmonary Complications in Hematopoietic Stem Cell Transplant Recipients—A Clinician Primer

Cited by 24 publications

References 146 publications

Pulmonary hypertension in patients with multiple myeloma: A comprehensive review

Pulmonary hypertension in patients with multiple myeloma: A comprehensive review

Diagnostic yield of bronchoscopy in children with leukemia or post hematopoietic stem cell transplant

Spectrum of bronchoalveolar bacterial microbiota following hematopoietic stem cell transplantation: age dependence and microbiota shifts

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