Diffuse Alveolar Hemorrhage in Hematopoietic Stem Cell Transplant Recipients

Afessa, Bekele; Tefferi, Ayalew; Litzow, Mark R.; Krowka, Michael J.; Wylam, Mark E.; Peters, Steve G.

doi:10.1164/rccm.200112-141cc

Cited by 190 publications

(200 citation statements)

References 44 publications

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“…1,30,31 Rates exceeding 35% have also been reported, particularly in the setting of acute respiratory failure and infection-associated DAH. 9,32 DAH was identified more often among early FOBs in our study.…”

Section: Discussionmentioning

confidence: 99%

Utility of early versus late fiberoptic bronchoscopy in the evaluation of new pulmonary infiltrates following hematopoietic stem cell transplantation

Shannon

Andersson

Lei

et al. 2009

Bone Marrow Transplant

166

143

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Pulmonary infiltrates frequently complicate hematopoietic SCT (HSCT). The utility of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) in the evaluation of new pulmonary infiltrates, particularly as it relates to optimal timing of the procedure, is unclear. Based on this, we retrospectively reviewed 501 consecutive, adult, nonintubated patients who underwent 598 BALs for evaluation of new pulmonary infiltrates during the first 100 days following HSCT to determine whether diagnostic yields for infection, subsequent antimicrobial treatment modifications and patient outcomes differed following early vs late referrals for the procedure. The overall yield of BAL for clinically significant pathogens was 55%. Notably, the yield was 2.5-fold higher among FOBs performed within the first 4 days of presentation (early FOB) compared to those performed late, and highest (75%) when performed within 24 h of clinical presentation. Rates of FOB-guided adjustments in antimicrobial therapy (51%) did not differ significantly between early and late examinations. However, late FOB-related antibiotic adjustments were associated with 30-day pulmonary-associated deaths that were threefold higher (6 vs 18%, P ¼ 0.0351). Major FOB-related complications occurred in only three (0.6%) patients. We conclude that early referral for FOB in this patient setting is associated with higher diagnostic yields and may favorably impact survival.

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Section: Discussionmentioning

confidence: 99%

Utility of early versus late fiberoptic bronchoscopy in the evaluation of new pulmonary infiltrates following hematopoietic stem cell transplantation

Shannon

Andersson

Lei

et al. 2009

Bone Marrow Transplant

166

143

View full text Add to dashboard Cite

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“…Infections, cardiac causes including heart failure, toxicity from pretransplant thoracic radiation, chemotherapy, early marrow engraftment, GVHD and cytokines have been postulated to have a role in the pathogenesis of AH after HSCT. [11][12][13][14][15][16][17][18] The reported mortality associated with AH varies from 70 to 100%. [11][12][13][14] Diffuse AH (DAH) was initially described in autologous HSCT recipients and since has been described with equal frequency in both allogeneic and autologous transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Outcome of alveolar hemorrhage in hematopoietic stem cell transplant recipients

Gupta

Jain

Warneke

et al. 2007

Bone Marrow Transplant

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“…DAH after HSCT is reported in 1-5% of autologous graft recipients and in 3-7% of allogeneic graft recipients. [1][2][3][4] Umbilical cord blood transplantation (CBT) from unrelated donors has recently increased in popularity for adult patients with hematological diseases who have no other suitable donor. However, DAH in the setting of post CBT has not been discussed in detail.…”

mentioning

confidence: 99%

“…Factors predictive of increased incidence of alveolar hemorrhage after HSCT include older age, use of myeloablative conditioning, infections (particularly respiratory infections) and presence of severe acute GVHD. [1][2][3][4]5 The underlying undetected infections have been considered to have a role in the pathogenesis of DAH in some reports. [1][2][3][4]6 One such report described an association between infections and hemorrhagic complications in an autopsy series.…”

mentioning

confidence: 99%

“…[1][2][3][4]5 The underlying undetected infections have been considered to have a role in the pathogenesis of DAH in some reports. [1][2][3][4]6 One such report described an association between infections and hemorrhagic complications in an autopsy series. 6 Although some reports have stated that high-dose corticosteroids cannot modify the poor outcomes associated with DAH, 3 high-dose corticosteroids have often been considered to be the treatment of choice for DAH.…”

mentioning

confidence: 99%

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