Obstructive Lung Disease After Allogeneic Bone Marrow Transplantation

Kurzrock, Razelle; Zander, Axel R.; Kanojia, Mahesh; Vellekoop, Lydia; Spitzer, Gary; Jagannath, Sundar; Schell, Sylvia; Peters, Lester J.; Dicke, Karel A.

doi:10.1097/00007890-198402000-00008

Cited by 36 publications

(13 citation statements)

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“…A connection with chronic graft versus host disease is likely since this late complication triggers a fibrotic process in several organs and shows some similarities to autoimmune diseases,24 such as systemic sclerosis, sys- Obstructive bronchiolitis can also occur as a complication of these autoimmune diseases. 1 7 On the basis of these results we conclude that patients with leukaemia receiving total body irradiation develop obstructive ventilatory disorders. The lung function of patients with severe aplastic anaemia, by contrast, is only slightly impaired in the first six months after transplantation.…”

Section: Discussionmentioning

confidence: 85%

Lung function changes after allogenic bone marrow transplantation.

Link¹,

Reinhard²,

Blaurock³

et al. 1986

Thorax

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The lung function of 21 patients with leukaemia (11 with acute myeloid leukaemia, six with acute lymphatic leukaemia, four with chronic myeloid leukaemia) and of five with severe aplastic anaemia was tested before and after allogenic bone marrow transplantation. Vital capacity (VC) was lowered in patients with leukaemia before transplantation. VC and FEV, fell significantly after transplantation. Residual volume (RV) and RV as a percentage of total lung capacity (RV % TLC) were already increased and rose significantly after transplantation. Patients with severe aplastic anaemia had noticeably increased RV and RV % TLC, values that did not change after transplantation. In contrast to the patients with aplastic anaemia, the patients with leukaemia had significantly reduced VC, RV, RV % TLC, and FEV1 before and after transplantation. The specific airway resistance (sRaw) was raised significantly before and after transplantation in the leukaemic patients. In addition, transfer coefficient (Kco) fell significantly more after transplantation in the patients with leukaemia than in those with severe aplastic anaemia. In three patients with histologically established obstructive bronchiolitis in conjunction with chronic graft versus host disease after transplantation, VC, FEV, and FEV, % VC fell, while RV, RV % TLC, and sRaw rose; Kco was far below normal. On the basis of these findings it is concluded that in patients with leukaemia obstructive disorders of ventilation develop or, if they are already present, worsen. In patients with severe aplastic anaemia lung function was not impaired in the early phase after transplantation. These differences are probably due to the more intensive immunosuppressive and cytotoxic preparatory regimen before transplantation in the leukaemic patients. Obstructive bronchiolitis, a complication of graft versus host disease, first manifests itself in a typical rise in specific airway resistance and must be treated early.

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Section: Discussionmentioning

confidence: 85%

Lung function changes after allogenic bone marrow transplantation.

Link¹,

Reinhard²,

Blaurock³

et al. 1986

Thorax

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“…In most patients disease progresses to a fatal outcome, although corticosteroid and other immunosuppressive agents are effective in a limited proportion of cases [9,21,26,38]. Thus, this serious complication has become a target of interest for haematologists as well as pulmonologists.…”

Section: And R O L E S : Toyoharu Yokoi · Norio Hirabayashi · Masafumi mentioning

confidence: 99%

Broncho-bronchiolitis obliterans as a complication of bone marrow transplantation: a clinicopathological study of eight autopsy cases

Yokoi

Hirabayashi²,

Ito

et al. 1997

Virchows Archiv

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We identified eight patients with bronchiolitis obliterans (BO) in the autopsies of 81 bone marrow transplant (BMT) recipients. Rapidly progressive dyspnoea and cough were the main presenting symptoms in all eight patients, associated with overinflation and/or infiltrative opacity seen on chest X-ray and obstructive disorder revealed by pulmonary function tests. Early lesions were characterized by epithelial loss and an inflammatory infiltrate containing foamy histiocytes with mild luminal narrowing. Partial or total occlusion of the bronchiolar lumina by fibrous connective tissue was the feature of late lesions. Both changes were coexistent in all cases. In one case, small bronchi with cartilage were also affected by the obstructive process, showing bronchitis obliterans. All eight patients showed non-obstructive broncho-bronchiolitis characterized by denuding of respiratory epithelium, mural oedema and an inflammatory infiltrate in addition to BO, and these changes were also seen in 18 patients without BO. The submucosal glands of large bronchi and the trachea showed mucous retention and a mild inflammatory infiltrate in four of the eight patients. Coexistent infectious processes were seen in all cases, cytomegalovirus and Aspergillus being the most frequent organisms. BO probably develops as an immunopathological event related to graft-versus-host disease (GVHD) during the impaired immune status phase of the post-BMT period, possibly initiated by infection. Bronchial gland involvement in chronic GVHD is one of the factors responsible for this abnormal immune status.

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“…Causes of obstruction are varied and include bronchitis, bronchiolitis obliterans, emphysemalike changes, and bronchospasm (28). Spontaneous pneumothoraces have been reported in bone marrow transplant recipients with obstructive airway disease from chronic GVHD (39,40). The pneumothoraces occur after the lung disease progresses to end stage.…”

Section: Posttransplant Considerationsmentioning

confidence: 99%

The pleural space and organ transplantation.

Judson

Sahn²

1996

Am J Respir Crit Care Med

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Pleural disease both before and after organ transplantation has important implications. Pleural effusions are common in candidates for heart, liver, and kidney transplantation. A thoracentesis is not mandatory in these patients, but it should be performed if clinical or radiologic features suggest that the effusion is not the result of organ failure. Posttransplant pleural infections and pleural PTLD relate to the level and duration of immunosuppression and are probably not organ-specific. Organ-specific pleural complications include pleural effusion from hepatic venoocclusive disease, spontaneous pneumothorax associated with obstructive airway disease from chronic GVHD after bone marrow transplantation, and early pleural effusion from urinothorax and late effusion from perirenal lymphocele years after kidney transplantation. The treatment of pleural disease in potential lung transplant candidates should minimize the extent of pleurodesis. Pleural effusions are expected sequelae after lung transplantation, and they may be harbingers of acute rejection. Interpleural communication, an expected finding after heart-lung transplantation or double-lung transplantation with a "clamshell" incision, has therapeutic implications.

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Obstructive Lung Disease After Allogeneic Bone Marrow Transplantation

Cited by 36 publications

References 0 publications

Lung function changes after allogenic bone marrow transplantation.

Lung function changes after allogenic bone marrow transplantation.

Broncho-bronchiolitis obliterans as a complication of bone marrow transplantation: a clinicopathological study of eight autopsy cases

The pleural space and organ transplantation.

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