Lung diseases after bone marrow transplantation

Abstract

The case histories of 72 subsequently treated patients - 44 with acute leukemia, 10 with chronic myeloid leukemia, 16 with severe aplastic anemia and 2 with neuroblastoma - were analyzed after bone marrow transplantation (BMT) with respect to pulmonary diseases. Thirty-eight patients suffered from a total of 51 pulmonary complications, which led to death in 20. Of 13 patients, 3 died of bacterial pneumonia, all of them during granulocytopenia; 2 of 6 patients died of fungal pneumonia and 2 out of 3 of a mixed bacterial-mycotic infection. Adult respiratory distress syndrome (ARDS) led to death in 2 patients. A granulocyte count under 500/microliter correlated significantly (P less than 0.002) with the fatal outcome of bacterial, fungal and ARDS pneumonia as well as with bronchitis. Viral pneumonia led to death in 8 of 9 patients; in each there was a significant correlation (P less than 0.05) with graft-versus-host disease (GvHD). Patients with repeated episodes of pulmonary illness had significantly more chronic GvHD (P less than 0.05); several of these patients displayed a reduction in helper T cells and an increase in suppressor T cells in the peripheral blood. The natural killer (NK) cells were reduced and the percentage of activated NK cell level lay between 6% and 69%. B-cells were absent or deficient. These findings explain in part the absence of specific antibody reactivity. Five of these patients also contracted GvHD-associated obstructive bronchiolitis, which did not respond to therapy. Pulmonary infiltrates of unknown origin (including idiopathic interstitial pneumonia) occurred in 8 of the patients (11.1%), with a fatal outcome in 3 patients. Significant changes (P less than 0.05) in lung function after BMT appeared in the form of reduced vital capacity (VC) increased residual volume (RV) and an increase in RV expressed as the percentage of total lung capacity. Pulmonary diseases were the most common complication and cause of death in our patients after BMT.

Severe respiratory failure requiring ICU admission in bone marrow transplant recipients

“…In this study, among ventilated patients for pneumonitis, 81% died. In the study of L ink et al [20], among 51 episodes of pulmonary complications, 39% died. Mortality was higher in patients in early neutropenic phase after bone marrow transplantation.…”

Allogeneic bone marrow transplantation for Langerhans' cell histiocytosis

“…Pulmonary complications are one of the major problems after BMT. 25 Therefore, it is pos-sible that the BMT-related risks are elevated in cases of LCH with lung involvement. This may limit the application of this therapy to cases of LCH without involvement of the lung.…”

Bacterial Pathogens Causing Pneumonia Post Hematopoietic Stem Cell Transplant: The Chronic GVHD Population

“…The most significant risk factors include structural lung illnesses, hematological neoplasms, transplantation, skin burns, recently used antibiotics, the presence of implants, prolonged hospitalization, and mechanical ventilation [ 51 ]. Eleven cases were found to have infections due to P. aeruginosa ( Table 5 ) [ 36 , 53 , 54 , 55 ]. All patients received an allogeneic transplant and one patient had bronchiectasis [ 36 , 53 , 54 , 55 ].…”

“…Eleven cases were found to have infections due to P. aeruginosa ( Table 5 ) [ 36 , 53 , 54 , 55 ]. All patients received an allogeneic transplant and one patient had bronchiectasis [ 36 , 53 , 54 , 55 ].…”