Pulmonary dysfunction in pediatric hematopoietic stem cell transplant patients: Overview, diagnostic considerations, and infectious complications

Abstract

Pulmonary complications are among the most common and serious sequelae seen in hematopoietic stem cell transplantation (HSCT) recipients. This two-part review addresses the incidence and impact of pulmonary complications in pediatric HSCT patients. In this first part we review the available data for the use of diagnostic modalities in this population, including flexible bronchoscopy with bronchoalveolar lavage (BAL) and open lung biopsy (OLB). We also review the many infectious pulmonary complications that may occur in pediatric HSCT recipients, utilizing the traditional chronologic divisions of neutropenic phase (0-30 days following HSCT), early phase (30-100 days), and late phase (>100 days).

A Comparison of Bronchoalveolar Lavage versus Lung Biopsy in Pediatric Recipients after Stem Cell Transplantation

“…Our analysis demonstrates that, among our diverse patient population, the diagnostic yield of BAL was 40%. This is consistent with the diagnostic yield of BAL in pediatric HSCT recipients described by others in smaller series, which range from 29% to 68% [7,8]. …”

“…The cohort described is a heterogeneous group, including patients with differing underlying diseases and conditioning regimens, including MAC and RTC regimens, as well as both autologous and allogeneic donor sources. In pediatric patients with pulmonary complications after HSCT, BAL remains the first-line diagnostic procedure for patients with pulmonary dysfunction [7]. Our analysis demonstrates that, among our diverse patient population, the diagnostic yield of BAL was 40%.…”

“…To establish an earlier, more definitive diagnosis, bronchoalveolar lavage (BAL) is regarded as an initial diagnostic tool in pediatric immunocompromised patients with pulmonary dysfunction [6]. However, the diagnostic yield of BAL in pediatric HSCT recipients has been reported as varying from 29% to 68%, with a reduced yield in those patients with grade II to IV graft-versus-host disease (GVHD) and in those receiving immunosuppressive therapy [7,8]. It has been suggested that some of this variation could result from the procedure’s timing, with higher diagnostic yield and favorable impact on survival resulting from early use of BAL, but this requires further investigation [9].…”

Non-atopic IgE and eosinophil cationic protein after allogeneic hematopoietic stem cell transplantation in children

“…Historically, about 50% of all pneumonias observed after HSCT have been attributed to bacterial, viral, or fungal infections. Risk factors for bacterial pneumonia include neutropenia and myeloablative therapy [8]. Non-infectious pulmonary complications such as bronchiolitis obliterans (BO) develop in 30-60% of HSCT patients [2,23].…”

Exhaled nitric oxide and pulmonary complications after paediatric stem cell transplantation

“…These complications are infectious or non-infectious and are classified as early or late depending on whether they occur before or after day 100 after transplantation [12]. Several risk factors for infectious complications including neutropenia and myeloablative therapy [8] have been published, while non-myeloablative conditioning regimen and graft source may predispose for non-infectious pulmonary complications such as pulmonary graft versus host disease (GvHD). Yet, reliable predisposing risk factors have not been established, partly due to insufficient understanding of the exact underlying pathophysiologic mechanisms of these diseases [1,12].…”