Pulmonary Complications of Malignancies and Blood and Marrow Transplantation

Jayasuriya, Geshani; Lin, Benjamin; Keogh, Steven; Selvadurai, Hiran

doi:10.1007/978-3-319-69620-1_4

Cited by 3 publications

(3 citation statements)

References 145 publications

(265 reference statements)

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“…Hematopoietic stem cell transplantation (HSCT) is a possible radical cure for hematological malignancies and hereditary diseases (1). With the development and progress of technology, more patients gain HSCT opportunities, but complications after transplantation seriously affect its efficacy (2), and concurrent lung disease after HSCT increases the risk of death by nearly 50% (3). Lung injury after HSCT can be divided into infectious and noninfectious types according to the mechanism of occurrence.…”

Section: Introductionmentioning

confidence: 99%

Lung transplantation for bronchiolitis obliterans after hematopoietic stem cell transplantation: a retrospective single-center study

Liang¹,

Chen²,

Zhou³

et al. 2022

Ann Transl Med

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Background: Bronchiolitis obliterans (BO) is one of the most common late non-infectious pulmonary complications after hematopoietic stem cell transplantation (HSCT). Lung transplantation (LT) is the only cure for patients with end-stage BO, but the overall efficacy is rarely reported. Our study aims to conclude and elucidate the clinical experience of our single center and provide a reference for the current selection of treatment.Methods: We retrospectively analyzed the medical records of six patients with post-HSCT BO who received LT in our center from 2015 to 2019. The collected information included demographic data, surgery-related conditions, and postoperative follow-up data, which covered blood tests, infection status assessment, lung function assessment, anesthesia assessment, function assessment of other organs and so on. All patients were regularly followed up after discharge, which in the first year, was performed every 3 months. Over the next 2 years, patients were assessed every 6 months, and after 3 years, the frequency was once annually.Results: The mean age of patients at LT time was 28±13 years, with an interval of 72±48 months from HSCT. All patients developed hypercapnia with an average carbon dioxide partial pressure (pCO 2 ) of 71.1±20.8 mmHg. Preoperative pulmonary function tests showed the mean actual forced expiratory volume in 1 second (FEV1) was 16.7%±5.9% of the predicted value in four patients. After assessment, four patients adopted sequential bilateral LT and two adopted right-sided LT. Due to hemodynamic instability, five patients adopted intraoperative assistance of extracorporeal membrane oxygenation (ECMO). One patient died of septic shock 9 days after surgery, and the other five survived healthy for 53±23 months. The actual value of FEV1 at 3 months postoperatively accounted for 57.9%±15.3% of the predicted value. No patients had recurrence of BO.Conclusions: LT may be a treatment worthy of consideration in patients with post-HSCT end-stage BO because it can improve lung function, quality of life and prolong survival of these selected patients.

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Section: Introductionmentioning

confidence: 99%

Lung transplantation for bronchiolitis obliterans after hematopoietic stem cell transplantation: a retrospective single-center study

Liang¹,

Chen²,

Zhou³

et al. 2022

Ann Transl Med

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“…Acute pulmonary complications of leukemia include pulmonary leukostasis and leukemic clotting, leukemic cell lysis syndrome, and hyperleukocytic reaction. While some hematologic malignancies of adulthood rarely lead to alveolar proteinosis and amyloidosis, these conditions are not described in children [ 2 , 3 ]. Pleural involvement in leukemia/lymphoma is expected due to the primary disease or a parapneumonic effusion with chronic pleuritis sequelae as a consequence.…”

Section: Underling Disease Before Hsctmentioning

confidence: 99%

Hematopoietic Stem Cells Transplant (HSCT)-Related Chronic Pulmonary Diseases: An Overview

Traunero,

Peri,

Badina

et al. 2023

Children

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Recipients of HSCT have a high risk of infective and non-infective pulmonary diseases. Most patients with pulmonary involvement present multiple pathogenetic mechanisms simultaneously with complex interactions. Therefore, it can be difficult to distinguish the contributions of each one and to perform studies on this subject. In this opinion article, we discuss only chronic pulmonary manifestations, focusing on LONIPCs (late-onset non-infectious pulmonary complications). This term embraces drug-related toxicity, allergies, and chronic pulmonary graft versus host disease (GvHD) in all its recently identified clinical variants. Among LONIPCs, GvHD represents the most critical in terms of morbidity and mortality, despite the rapid development of new treatment options. A recently emerging perspective suggests that pulmonary lung rejection in transplant patients shares striking similarities with the pathogenesis of GvHD. In a pulmonary transplant, the donor organ is damaged by the host immune system, whereas in GvHD, the donor immune system damages the host organs. It constitutes the most significant breakthrough in recent years and is highly promising for both hematologists and thoracic transplant surgeons. The number of patients with LONIPCs is scarce, with heterogenous clinical characteristics often involving several pathogenetic mechanisms, making it challenging to conduct randomized controlled trials. Therefore, the body of evidence in this field is scarce and generally of low quality, leading to jeopardized choices in terms of immunosuppressive treatment. Moreover, it risks being outdated by common practice due to the quick evolution of knowledge about the diagnosis and treatment of LONIPCs. The literature is even more pitiful for children with pulmonary involvement related to HSCT.

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“…Invasive procedures assist in the accurate identification of the causative agent that will help in the verification of its susceptibility to antimicrobial drugs in order to adjust the management strategy with the addition or discontinuation of certain pharmacological agents. Those valuable results are frequently obtained through BAL, CT-guided fine-needle aspiration or open lung biopsy (OLB) [20][21][22][23].…”

Section: Invasive Approachesmentioning

confidence: 99%

Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia

Voulgaridou

Athanasiadou

et al. 2020

Diseases

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Infections frequently complicate the treatment course in children with hematologic malignancies undergoing chemotherapy. Febrile neutropenia (FN) remains a major cause of hospital admissions in this population, and respiratory tract is often proven to be the site of infection even without respiratory signs and symptoms. Clinical presentation may be subtle due to impaired inflammatory response. Common respiratory viruses and bacteria are widely identified in these patients, while fungi and, less commonly, bacteria are the causative agents in more severe cases. A detailed history, thorough clinical and basic laboratory examination along with a chest radiograph are the first steps in the evaluation of a child presenting signs of a pulmonary infection. After stratifying patient’s risk, prompt initiation of the appropriate empirical antimicrobial treatment is crucial and efficient for the majority of the patients. High-risk children should be treated with an intravenous antipseudomonal beta lactam agent, unless there is suspicion of multi-drug resistance when an antibiotic combination should be used. In unresponsive cases, more invasive procedures, including bronchoalveolar lavage (BAL), computed tomography (CT)-guided fine-needle aspiration or open lung biopsy (OLB), are recommended. Overall mortality rate can reach 20% with higher rates seen in cases unresponsive to initial therapy and those under mechanical ventilation.

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Pulmonary Complications of Malignancies and Blood and Marrow Transplantation

Cited by 3 publications

References 145 publications

Lung transplantation for bronchiolitis obliterans after hematopoietic stem cell transplantation: a retrospective single-center study

Lung transplantation for bronchiolitis obliterans after hematopoietic stem cell transplantation: a retrospective single-center study

Hematopoietic Stem Cells Transplant (HSCT)-Related Chronic Pulmonary Diseases: An Overview

Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia

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