Background: Pulmonary complications are the most probable causes of life-threatening episodes in hematopoietic stem cell transplantation patients. There are a variety of causes including infectious and non-infectious etiologies to result in those events. We analyzed the experience of our institution to treat such kind of patients. Methods: For all patients after the treatment of hematopoietic stem cell patients once developed respiratory symptoms, we performed plain fi lm X ray and CT scan of lungs and prepared bronchoscopic examination including transbronchoscopic biopsy and bronchioloalveolar lavarge, and transcutaneous core needle biopsy of lung or thoracoscopic resection of lung tissue to check cytology, histopathology, and sent for bacterial, fungal, and tuberculous cultures and special stains for bacteria, fungus, tuberculosis, CMV, HSV, PJP, and PCR for CMV, HSV, PJP, RSV, infl uenza, parainfl uenza, adenovirus, and VZV. Results: Between March 2001 and November 2011, we have 181 patients undergoing hematopoietic stem cell transplantation at our institution including 108 patients received allotransplant and 73 autotransplant. Forty-fi ve episodes of pulmonary complications occurred in allogeneic stem cell transplant except one invasive pulmonary aspergillosis occurred in an [P637]S201 autotransplant patient (24.8% in all patients or 40.7% in allotransplant patients). For allogeneic stem cell transplantation patients, the incidence of the diverse etiology of pulmonary complications are as follows: CMV pneumonia 11.1%, chronic GVHD or bronchiolitis obliterans 7.4%, capillary leak or engraftment syndrome 5.6%, fungal pneumonia 3.7%, tuberculous pneumonia 3.7%, unspecifi ed pneumonia 3.7%, pulmonary hemorrhage 2.8%, RSV pneumonia 1.9%, HSV pneumonia 0.9%, and leukemic infi ltrate 0.9%. Moreover, the mortality rate of these pulmonary complications were up to 46.7% (21 patients in these 45 episodes). Conclusions: Post-transplant pulmonary complication is a lifethreatening event and the two most probable causes are CMV pneumonia and chronic GVHD related bronchiolitis obliterans. It is crucial to make early diagnosis and to deliver the most appropriate treatment for these patients.
Full conference title:
Annual Meeting of the EBMT, 38th
- EBMT 38th (2012)