Pulmonary Complications in Adult Blood and Marrow Transplant Recipients

Sharma, Sunita; Nadrous, Hassan F.; Peters, Steve G.; Tefferi, Ayalew; Litzow, Mark R.; Aubry, Marie Christine; Afessa, Bekele

doi:10.1378/chest.128.3.1385

Cited by 151 publications

(97 citation statements)

References 45 publications

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“…None of the nine patients with a definite diagnosis of pulmonary aspergillosis at autopsy had a positive FOB-BAL. Sharma et al 27 also recently reported great discrepancy between pre-mortem diagnosis and autopsy findings in blood and bone marrow transplant patients with PCs. Recent studies using CT Scans, Aspergillus antigen detection, PCR Aspergillus antigen tests in BALF have reported an increase in FOB-BAL diagnostic yield, but the use of these tests is not generalized nor fully evaluated yet.…”

Section: Yield Of Fob-bal For the Diagnosis Of Infectious Pulmonary Cmentioning

confidence: 99%

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

et al. 2008

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In patients with hematological malignancy (HM) developing acute respiratory failure (ARF) bronchoalveolar lavage (BAL) is considered as a major diagnostic tool. However, the benefit/risk ratio of this invasive procedure is probably lower in the subset of patients with acute myeloid leukemia (AML). The study was to analyze the yield of BAL performed in HM patients (n ¼ 175) with AML or lymphoid malignancies (LM) admitted in intensive care unit (ICU) for ARF and pulmonary infiltrates. BAL was performed in 121 patients (53/73 AML patients (73%) and 68/102 LM patients (67%)) without a definite diagnosis at admission or contraindication for fiberoptic bronchoscopy. Life-threatening complications were noticed in 12/121 patients (10%). The overall diagnostic yield of BAL was 47% (25/53) in AML patients and 50% (34/68) in LM patients. A microorganism was recovered from BAL in 23% (12/53) of AML patients and 41% (28/68) of LM patients (Po0.005). BAL results induced significant therapeutic changes in 17% (9/53) of AML patients vs 35% (24/68) of LM patients (P ¼ 0.039). This study underlines the rather low diagnostic yield of BAL for infectious diagnosis and the low rate of therapeutic changes induced by its results in AML patients with ARF admitted in ICU.

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Section: Yield Of Fob-bal For the Diagnosis Of Infectious Pulmonary Cmentioning

confidence: 99%

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

et al. 2008

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“…[4][5][6][7] The benefit of this reduced relapse risk is often negated by significant non-relapse mortality, the major causes being GVHD, infection and diffuse alveolar damage. 4,8 Reduced-intensity conditioning (RIC) regimens have been developed that allow stable engraftment and low non-relapse mortality allowing allografting to be feasible in older patients. [9][10][11][12] Although these protocols are better tolerated, GVHD and infection remain considerable barriers to successful outcomes.…”

Section: Introductionmentioning

confidence: 99%

Alemtuzumab markedly reduces chronic GVHD without affecting overall survival in reduced-intensity conditioning sibling allo-SCT for adults with AML

Malladi

Peniket

Littlewood

et al. 2008

Bone Marrow Transplant

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By retrospective analysis of 88 patients from the British Society of Blood and Marrow Transplantation registry, we investigated the effect of in vivo T-cell depletion in HLA-identical sibling reduced-intensity conditioning (RIC) allografts for adult AML by comparing patients who received alemtuzumab with those without alemtuzumab conditioning. Both groups were equivalent for age, sex, karyotype and disease status at transplant. With a median follow-up of 27 months (3-72 months) and 48 months (7-72 months), the 2-and 5-year overall survival, with or without alemtuzumab, is 60 and 60% (P ¼ 0.80) and 61 and 53%, respectively (P ¼ 0.85). The 2-year nonrelapse mortality is 12% with alemtuzumab, and 17% without alemtuzumab (P ¼ 0.49). The 2-year relapse rate is 35% with alemtuzumab compared with 19% without alemtuzumab (P ¼ 0.28). Grades II-IV acute GVHD occurred in 22% (8/37) without alemtuzumab compared with 14% (7/51) given alemtuzumab (P ¼ 0.25). Extensive chronic GVHD occurred in 47% (14/30) not given alemtuzumab compared with 4% (2/45) who were given alemtuzumab (P ¼ 0.001). Among evaluable patients, the risk of infections was higher in those treated with alemtuzumab compared with those not treated with alemtuzumab (79 vs 57%, respectively, P ¼ 0.02). In conclusion, alemtuzumab has a beneficial effect by reducing chronic GVHD without affecting overall survival. Further studies are warranted before alemtuzumab can be recommended as standard in RIC allografts for AML.

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mentioning

confidence: 99%

“…1,3,4 Indeed, pulmonary complications are the commonest cause of death in bone marrow transplantation recipients. 4 In the early phase, these are frequently of infectious aetiology, but late-phase complications (100 days or more after transplant) are predominantly non-infectious in origin, and often are related to graft-vs-host disease in allogeneic bone marrow transplantation. [5][6][7][8] A common pattern of post bone marrow transplantation fibrosis is constrictive obliterative bronchiolitis, with airflow limitation and computed tomography (CT) changes of mosaic attenuation and air trapping.…”

mentioning

confidence: 99%

Pleuroparenchymal fibroelastosis in patients with pulmonary disease secondary to bone marrow transplantation

et al. 2011

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This study presents four patients who underwent bone marrow transplantation and subsequently developed pleuroparenchymal fibroelastosis, hitherto reported as an idiopathic condition. All presented clinically with pneumothorax and subpleural fibrosis on high-resolution computed tomography. In addition to the expected obliterative bronchiolitis, histopathology showed coexistent subpleural changes, and the relationship of pathology in multiple anatomic compartments in post bone marrow transplantation pulmonary disease is discussed.

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Pulmonary Complications in Adult Blood and Marrow Transplant Recipients

Cited by 151 publications

References 45 publications

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

Alemtuzumab markedly reduces chronic GVHD without affecting overall survival in reduced-intensity conditioning sibling allo-SCT for adults with AML

Pleuroparenchymal fibroelastosis in patients with pulmonary disease secondary to bone marrow transplantation

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