Pulmonary complications occurring after allogeneic bone marrow transplantation. A study of 130 consecutive transplanted patients

Abstract

This report deals with 81 pulmonary episodes occurring in 130 consecutive patients who underwent al-logeneic bone marrow transplantation for hematologic malignancy in the same unit over a 5-year period. These episodes observed in 69/130 patients (53%) were mostly of infectious origin, and were investigated by bronchoalveolar lavage (BAL). The main causes of pneumonia were: cytomegalovirus (CMV) (n = 25), bacterial pneumonia (n = 17), invasive aspergillosis (n = 11) and pulmonary hemorrhage (n = 9). The overall mortality due to or associated with pneumonia was 26/130 (20%). Graft-versus-host disease clearly increased the incidence of infectious pneumonia and the mortality due to or associated with pneumonia. Granulocyte transfusions did not influence the incidence of CMV pneumonitis. The main causes and risk factors for pneumonia are discussed. The role of BAL as a noninvasive procedure is stressed. Cancer 58:1047-1054, 1986 NEUMONITIS is a life threatening complication after P allogeneic bone marrow transplantation (BMT).'?* Previous immunodeficiency, underlying hematologic disease, pretransplant conditioning regimen, granulocyte transfusions, and graft-versus-host diseasee (GVHD) have been raised as the most important factors associated with an increased incidence of p n e ~ m o n i t i s. ~-~ Although non-bacterial nonfungal diffuse interstitial pneumonitis is perhaps the most interesting problem raised by the pulmonary complications after BMT,6 its frequency is lower than From the

The clinical importance of bronchoalveolar lavage in allogeneic SCT patients with pneumonia

“…5,8,22,23 Other studies have shown diagnostic yields of 51-80%. 3,19,[24][25][26] In total, 7 BALs were performed in children and contributed to the diagnosis in four of these. There are some difficulties associated with bronchoscopies in children, such as the frequent need for general anesthesia and difficulties in performing the procedure because of their small airways.…”

Are predictive factors clinically useful in bone marrow transplantation?

“…BMT is known to be associated with potential cardiac and pulmonary toxicities. [56][57][58][59] It is intuitive to believe that TRM would be influenced by abnormal cardiopulmonary function. Adequate cardiac function is required to handle the large amounts of fluids that are used in conjunction with high-dose chemotherapy.…”

Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation

“…Pulmonary complications develop in 30-60% of HSCT recipients. 1,2 Factors that influence the development of pulmonary complications in HSCT include previous infections, pre-transplant conditioning regimen, current or prior immunosuppressant and radiation treatment, type of stem cell transplant (autologous vs allogeneic), use of prophylactic antibiotics, and time elapsed since transplant. With the use of prophylactic antibiotics, the spectrum of pulmonary complications following HSCT has changed increasingly from infectious to non-infectious etiologies.…”