Pulmonary Complications of Bone Marrow Transplantation

Soubani, Ayman O.; Miller, Kenneth B.; Hassoun, Paul M.

doi:10.1378/chest.109.4.1066

Cited by 327 publications

(294 citation statements)

References 73 publications

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“…1 Long-term morbidities associated with HSCT, including chronic GVHD, are frequently seen. 2,3 Post transplantation constrictive bronchiolitis (PTCB) is the most common pulmonary complication among long-term survivors that may lead to progressive respiratory insufficiency and even death. [2][3][4][5][6] Due to the lack of uniform diagnostic criteria, the reported incidence of PTCB varies from 10 to 26%.…”

Section: Introductionmentioning

confidence: 99%

Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation

Bashoura

Gupta

Jain

et al. 2007

Bone Marrow Transplant

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Post transplantation constrictive bronchiolitis (PTCB) is the most common pulmonary complication among longterm survivors of allogeneic hematopoietic stem cell transplantation (HSCT). It is a late manifestation of GVHD. Its treatment with high-dose systemic corticosteroids and other immunosuppressive regimens is associated with multiple side effects. Topical corticosteroids are used for the treatment of other manifestations of GVHD to minimize these side effects. We conducted a retrospective analysis of a series of adult patients to evaluate the efficacy of high-dose inhaled corticosteroids in the treatment of PTCB. Seventeen patients with new-onset airflow obstruction were diagnosed with PTCB. Their forced expiratory volume in 1 s (FEV1) declined from a median of 84% (range, 56-119) before HSCT to 53% (26-82) after HSCT. All patients received inhaled fluticasone propionate 500-940 lg two times daily. Symptoms of airway obstruction improved and FEV1 stabilized 3-6 months after treatment. We conclude that high-dose inhaled corticosteroids may be effective in the treatment of PTCB and propose a plausible mechanism of its action. A prospective evaluation of its efficacy is warranted.

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Section: Introductionmentioning

confidence: 99%

Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation

Bashoura

Gupta

Jain

et al. 2007

Bone Marrow Transplant

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“…The differential diagnosis of such infiltrates includes a wide range of infectious and noninfectious conditions [4,5]. Early and definitive diagnosis is essential to guide therapy and may have an impact on the patient's prognosis.…”

Section: Introductionmentioning

confidence: 99%

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

et al. 2005

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Using a retrospective review of medical records, we sought the findings of surgical lung biopsy (SLB) in patients with hematological malignancy or hematopoietic stem cell transplantation (HSCT) and unexplained pulmonary infiltrates and to determine the impact of this procedure on management and outcome of these patients. Sixty-two patients who underwent SLB were evaluated; 31 patients had underlying hematological malignancy and 31 patients were HSCT recipients; 58% of whom underwent allogeneic HSCT. Thirty-three patients (53%) had focal infiltrates on chest CT scan while 29 (47%) had diffuse infiltrates. Thirteen patients were mechanically ventilated prior to SLB, and 27 (43%) were neutropenic. There were 66 diagnoses in the 62 patients, 44 (67%) were specific and 22 (33%) were nonspecific. The most common specific diagnoses were infection (29%), malignancy (27%), and inflammatory conditions (11%). Aspergillosis was the most common diagnosis of all biopsies (21%). SLB led to a change in therapy in 40% of patients and was associated with complications in 7 patients (11%). Specific diagnosis was more likely to lead to a change in therapy (48% vs. 27%, P = 0.06) and was associated with a lower mortality when compared to a nonspecific finding (30% vs. 59%, P = 0.02). Nonspecific diagnosis, on the other hand, was seen more in patients on mechanical ventilation prior to SLB compared to those off mechanical ventilation (69% vs. 27%, P = 0.02). SLB provides a specific diagnosis in the majority of patients with hematologic malignancy or HSCT recipients and unexplained pulmonary infiltrates. Specific diagnosis is more likely to lead to a change in therapy and is associated with a better outcome. Am. J. Hematol. 78:94-99, 2005. ª 2005 Wiley-Liss, Inc.

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“…Lung involvement by aGVHD is a highly controversial issue. Early works describing this entity [1,2] were later under discussion by other authors [3,4,5]. Animal models recently helped to understand this entity, and some authors consider donor T lymphocytes as one of the sources of lung damage after allogeneic hematopoietic transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Patient and donor were phenotypically identical (A 11,30 ; B 18,27 ; DR 1,17 ; Cw 1,5 ; DR 52 ; DQ 2,5 ). When mixed lymphocyte culture was performed with the patient and his father no response was found.…”

Section: Case Reportmentioning

confidence: 99%

“…However, a pulmonary interstitial syndrome with interstitial and peribronchial lymphocytic infiltrate with very good response to steroid treatment resembling aGVHD was later described [2]. Subsequent studies failed to show a relationship between these pictures and aGVHD [3,4,5]. However, recent papers have confirmed the role of donor T lymphocytes in immune-mediated inflammatory reactions in the lung [6,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Early onset of acute immune‐mediated lung injury in a child undergoing allogeneic peripheral blood transplantation

et al. 2001

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Animal models have recently clarified the lung injury after 1 allogeneic hematopoietic transplantation. These works have confirmed the role of donor T lymphocytes in immunemediated inflammatory reactions in the lung. We report here a fatal case of a 3-year-old child who developed acute respiratory failure coinciding with the onset of hyper-acute graft versus host disease (aGVHD) after allogeneic peripheral stem cell transplantation. aGVHD was refractory to treatment and the patient died on day +28. Lung necropsy showed interstitial pneumonia and peribronchial and perivascular infiltration by mononuclear cells, with no viral inclusions. These findings are not specific but have been found by some authors in animal models with acute immune-mediated lung injury related with donor T lymphocytes. Immune-mediated lung injury, as defined by animal models, should be considered in patients with severe signs of systemic aGVHD while excluding other known etiologies of pulmonary disease. Am.

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Pulmonary Complications of Bone Marrow Transplantation

Cited by 327 publications

References 73 publications

Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation

Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

Early onset of acute immune‐mediated lung injury in a child undergoing allogeneic peripheral blood transplantation

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