Pulmonary cytolytic thrombi: a newly recognized complication of stem cell transplantation

Woodard, J. P.; Gulbahce, Evin H; Shreve, M.; Steiner, Marie; Peters, Charles; Hite, Stephen H.; Ramsay, Norma K.C.; DeFor, Todd E.; Baker, K. Scott

doi:10.1038/sj.bmt.1702137

Cited by 56 publications

(42 citation statements)

References 27 publications

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“…89 In the only published study, nine of the 13 HSCT recipients with pulmonary cytolytic thrombi were alive at a median followup of 1.5 years. 89 All received antibiotics, and nine were treated with systemic corticosteroids. 89 The published reports on pulmonary cytolytic thrombi are limited to one institution.…”

Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

“…90 Its time of onset ranges between 8 and 343 days (median 72) after transplant. 89 Most patients improve clinically within 1-2 weeks and radiographically over weeks to months. 89 In the only published study, nine of the 13 HSCT recipients with pulmonary cytolytic thrombi were alive at a median followup of 1.5 years.…”

Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

“…89 Most patients improve clinically within 1-2 weeks and radiographically over weeks to months. 89 In the only published study, nine of the 13 HSCT recipients with pulmonary cytolytic thrombi were alive at a median followup of 1.5 years. 89 All received antibiotics, and nine were treated with systemic corticosteroids.…”

Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

“…89 It occurs almost exclusively in children with GVHD and is characterized by fever and pulmonary nodules. Biopsy of the nodules shows necrotic, basophilic thromboemboli with amorphous material suggestive of cellular breakdown products.…”

Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

“…89 All received antibiotics, and nine were treated with systemic corticosteroids. 89 The published reports on pulmonary cytolytic thrombi are limited to one institution.…”

Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

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Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation

Afessa

Tefferi

2001

Bone Marrow Transplant

275

308

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Summary:Pulmonary complications develop in 30-60% of hematopoietic stem cell transplants (HSCT). The main, late onset, non-infectious complications include Bronchiolitis obliterans (BO), Bronchiolitis obliterans organizing pneumonia (BOOP), and idiopathic pneumonia syndrome (IPS). BO and BOOP occur almost exclusively in allogeneic HSCT, and have 61% and 21% mortality rates, respectively. BOOP responds favorably to corticosteroids. IPS has less than 15% 1-year survival. Bone Marrow Transplantation (2001) 28, 425-434. Keywords: pulmonary complications; Bronchiolitis obliterans; Bronchiolitis obliterans organizing pneumonia; interstitial pneumonia; hematopoietic stem cell transplantation Despite the success in treating otherwise fatal diseases, HSCT is associated with multiple complications. Pulmonary complications develop in 30-60% of HSCT recipients. 1,2 Factors that influence the development of pulmonary complications in HSCT include previous infections, pre-transplant conditioning regimen, current or prior immunosuppressant and radiation treatment, type of stem cell transplant (autologous vs allogeneic), use of prophylactic antibiotics, and time elapsed since transplant. With the use of prophylactic antibiotics, the spectrum of pulmonary complications following HSCT has changed increasingly from infectious to non-infectious etiologies. The times of onset and distinguishing features of the main non-infectious pulmonary complications are shown in Figure 1 and Table 1. This review will focus on the late-onset, non-infectious pulmonary complications in HSCT recipients. An algorithmic approach is outlined in Figure 2. Since most of the treatable pulmonary complications in HSCT recipients are diagnosed non-invasively and by bronchoscopy, we rarely subject our patients to surgical lung biopsy. However, in patients with suspected BOOP and when bronchoscopy is contraindicated or non-diagnostic, we occasionally resort to video-assisted thoracoscopic surgical lung biopsy. Abnormal lung functionRestrictive and obstructive ventilatory defects, and gas transfer abnormalities occur frequently in HSCT recipients. 3,4 In a study of 52 young, asymptomatic HSCT recipients, 38% had abnormalities in pulmonary function tests (PFT): 23% restrictive defect with or without impaired gas transfer and 15% isolated impaired gas transfer. 3 An abnormal pulmonary function test is a risk factor for pulmonary complications. 5-9 However, the role of PFT in identifying HSCT recipients at risk for pulmonary complications needs further investigation. The PFT findings in BO, BOOP, and delayed pulmonary toxicity syndrome are listed in Table 2. Bronchiolitis obliterans (BO)GVHD is a frequent complication of allogeneic HSCT. 10 The pulmonary morphological manifestations of GVHD include diffuse alveolar damage, lymphocytic bronchitis/ bronchiolitis with interstitial pneumonitis, BOOP, and BO. 11 BO is a nonspecific inflammatory injury affecting

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Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

“…89 All received antibiotics, and nine were treated with systemic corticosteroids. 89 The published reports on pulmonary cytolytic thrombi are limited to one institution.…”

Section: Pulmonary Cytolytic Thrombimentioning

confidence: 99%

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