Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation

Fan, Kimberly; McArthur, Jennifer; Morrison, R. Ray; Ghafoor, Saad

doi:10.3389/fonc.2020.01757

Cited by 22 publications

(20 citation statements)

References 104 publications

(289 reference statements)

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“…This patient had risk fac tors for DAH, includ ing sta tus as a cord blood recip i ent, defi brotide treat ment, delayed engraft ment, though not sirolimus pro phy laxis, total body irra di a tion (TBI), and myeloablation. 2,3 Patients often pres ent < 30 days after HCT and do poorly, with <25% of adults and <16% of chil dren sur viv ing a year. 4,5 While the path o gen e sis is incom pletely under stood, DAH is thought to reflect accu mu lated dam age from con di tion ing reg i mens, aber rant immune response, and sub se quent dam age to the endo the lium, resulting in hem or rhage into alve o lar spaces.…”

Section: Diffuse Alve O Lar Hem or Rhagementioning

confidence: 99%

Noninfectious lung complications of hematopoietic cell transplantation

Williams

2021

Hematology

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Noninfectious lung diseases contribute to nonrelapse mortality. They constitute a spectrum of diseases that can affect the parenchyma, airways, or vascular pulmonary components and specifically exclude cardiac and renal causes. The differential diagnoses of these entities differ as a function of time after hematopoietic cell transplantation. Specific diagnosis, prognosis, and optimal treatment remain challenging, although progress has been made in recent decades.

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Section: Diffuse Alve O Lar Hem or Rhagementioning

confidence: 99%

Noninfectious lung complications of hematopoietic cell transplantation

Williams

2021

Hematology

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“…SOS, formerly referred to as hepatic veno-occlussive disease (VOD), may be diagnosed by modified EBMT Pediatric Criteria which require two or more of the following: unexplained consumptive and transfusion-refractory thrombocytopenia; otherwise unexplained weight gain on three consecutive days despite the use of diuretics, or a weight gain of more than 5% above baseline value within 72 h; bilirubin increasing from baseline on three consecutive days, or bilirubin 2 mg/dl or more within 72; hepatomegaly (best if supported by imaging) above baseline value; and ascites (best if supported by imaging) above baseline ( 21 ). DAH is a devastating non-infectious complication following HCT defined as a syndrome of hypoxia, dyspnea, infiltrates on chest radiograph, and progressively bloodier bronchoalveolar lavage or the presence of hemosiderin-laden macrophages on microscopy ( 22 , 23 ). IPS is defined as the presence of multi-lobar infiltrates by chest radiograph or computed tomography scan, need for supplemental oxygenation with declining pulse oximetry and no identifiable pulmonary infection ( 24 ).…”

Section: Introductionmentioning

confidence: 99%

Perspective: A Framework to Screen Pediatric and Adolescent Hematopoietic Cellular Therapy Patients for Organ Dysfunction: Time for a Multi-Disciplinary and Longitudinal Approach

Ahmad

Mahadeo

2021

Front. Oncol.

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Hematopoietic Cell Transplantation (HCT) is a potentially curative therapy for children and adolescent/young adults (AYA) with high-risk malignancies as well as some non-malignant genetic diseases. However, HCT may be associated with endotheliopathies and/or organ dysfunction that may progress to pediatric multi-organ dysfunction syndrome (pMODS) and require critical care intervention. Discipline specific scoring systems may be used to characterize individual organ dysfunction, but the extent to which they are used to prospectively monitor HCT patients with mild dysfunction is unknown. Further, separate scoring systems may be used to define risk of mortality and inform prognostication among those who require critical care support. Our understanding of the epidemiology, risk factors, morbidity, mortality, required monitoring, optimal prevention strategies and appropriate management of children undergoing HCT who develop organ dysfunction, endotheliopathies and/or progress to pMODS is poor. Discipline-specific registries and clinical studies have described improving outcomes for children undergoing HCT, including those who require critical care support; however, longitudinal studies/prospective registries that capture common data elements among HCT patients with and without organ dysfunction, endotheliopathies and pMODS are needed to facilitate inter-disciplinary collaboration and optimally characterize the risk profiles, define screening and prophylaxis regimens and mitigate toxicity.

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“…DAH is a subcategory of IPS that is defined by hemorrhagic alveolitis. In pediatric and adult allogeneic HSCT, incidence of DAH ranges from 5% to 12% with a median onset of 19 days as compared to autologous HSCT recipients where DAH incidence ranges from 2.1% to 12%, with a median time of onset of 12 days (5,58,62,63). Definitive diagnosis requires a BAL sample with at least 20% of hemosiderin-laden macrophages, blood in 30% of alveolar surfaces, with increasingly bloody samples (15,58,64).…”

Section: Diffuse Alveolar Hemorrhagementioning

confidence: 99%

“…Currently, treatment recommendations include high-dose steroids and supportive care (5,62). Small studies have been performed in patients with DAH (both transplant induced and not) that have evaluated inhaled/ nebulized tranexamic acid ± recombinant activated factor VII with reported success; however, further investigation with a larger sample size is required before integrating this into standard of care (63,66,67). Despite early intervention and supportive care, mortality historically has been up to 80%-100% in allogeneic HSCT patients.…”

Section: Diffuse Alveolar Hemorrhagementioning

confidence: 99%

Pulmonary Complications After Pediatric Stem Cell Transplant

et al. 2021

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The number of disorders that benefit from hematopoietic stem cell transplantation (HSCT) has increased, causing the overall number of HSCT to increase accordingly. Disorders treated by HSCT include malignancy, benign hematologic disorders, bone marrow failure syndromes, and certain genetic diagnoses. Thus, understanding the complications, diagnostic workup of complications, and subsequent treatments has become increasingly important. One such category of complications includes the pulmonary system. While the overall incidence of pulmonary complications has decreased, the morbidity and mortality of these complications remain high. Therefore, having a clear differential diagnosis and diagnostic workup is imperative. Pulmonary complications can be subdivided by time of onset and whether the complication is infectious or non-infectious. While most infectious complications have clear diagnostic criteria and treatment courses, the non-infectious complications are more varied and not always well understood. This review article discusses pulmonary complications of HSCT recipients and outlines current knowledge, gaps in knowledge, and current treatment of each complication. This article includes some adult studies, as there is a significant paucity of pediatric data.

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Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation

Cited by 22 publications

References 104 publications

Noninfectious lung complications of hematopoietic cell transplantation

Noninfectious lung complications of hematopoietic cell transplantation

Perspective: A Framework to Screen Pediatric and Adolescent Hematopoietic Cellular Therapy Patients for Organ Dysfunction: Time for a Multi-Disciplinary and Longitudinal Approach

Pulmonary Complications After Pediatric Stem Cell Transplant

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