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The Egyptian Journal of Bronchology
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Pulmonary complications within the first year after bone marrow transplantation

Egyptian Journal of Bronchology volume 12, pages 233–239 (2018)Cite this article

Abstract

Background

Pulmonary complications (PCs) are a significant cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. Pulmonary infiltrates in such patients pose a major challenge for clinicians because of the wide differential diagnosis of infectious and noninfectious conditions. It is rare for the diagnosis to be made by chest radiograph, and commonly these patients will need further invasive and noninvasive studies to confirm the etiology of the pulmonary infiltrates.

Aim

The aim of this research was to study the pattern of lower respiratory tract infection within the first year after HSCT.

Patients and methods

This is a prospective study of 60 patients receiving HSCT (because of hematological and nonhematological malignancy) at Kuwait Cancer Center within the first year after transplantation for any suspicious respiratory tract infection. Patients were subjected to sputum and blood examination along with bronchoscopic examination and bronchoalveolar lavage if indicated, and all samples were subjected to microbiological examination for diagnosis of the causative organism.

Results

Sixty patients were studied for PCs either infectious or noninfectious within the first year after HSCT. The most common complications were infectious complications (70%). Severe PCs were the main causes of death in 13 (21.6%) cases. The PCs were more common and recurrent in allogeneic bone marrow transplantation (BMT) recipients, in whom PCs contributed to death in 12 cases. Bacterial infection, pulmonary edema, and diffuse alveolar hemorrhage were seen more in the early post-BMT period (<100 days), whereas viral, fungal infection, graft-versus-host disease, and bronchiolitis obliterans were seen more in the late post-BMT period (>100 days).

Conclusion

Lower respiratory tract infection is a serious complication after BMT transplantation. Mixed bacterial and opportunistic infections are the most common etiologies. Pulmonary infiltrates in such patients pose a wide differential diagnosis of infectious and noninfectious conditions. PCs are a significant causes of death in BMT recipients.

References

  1. Sirithanakul K, Salloum A, Klein JL, Soubani AO. Pulmonary complications following hematopoietic stem cell transplantation:diagnostic approaches. Am J Hematol 2005;80:137–146.

    Article  Google Scholar 

  2. Del Campo L, León NG, Palacios DC, Lagana C, Tagarro D. Abdominal complications following hematopoietic stem cell transplantation. Radiographics 2014;34:396–412.

    Article  Google Scholar 

  3. Pena E, Souza CA, Escuissato DL, Gomes MM, Allan D, Tay J. Noninfectious pulmonary complications after hematopoietic stem cell transplantation:practical approach to imaging diagnosis. Radiographics 2014;34:663–683.

    Article  Google Scholar 

  4. Chi AK, Soubani AO, White AC, Miller KB. An update on pulmonary complications of hematopoietic stem cell transplantation. Chest 2013;144:1913–1922.

    Article  Google Scholar 

  5. Levine DS, Navarro OM, Chaudry G, Doyle JJ, Blaser SI. Imaging the complications of bone marrow transplantation in children. Radiographics 2007;27:307–324.

    Article  Google Scholar 

  6. Wah TM, Moss HA, Robertson RJ, Barnard DL. Pulmonary complications following bone marrow transplantation. Br J Radiol 2003;76:373–379.

    Article  CAS  Google Scholar 

  7. Bachanova V, Brunstein CG, Burns LJ. Fewer infections and lower infection-related mortality following non-myeloablative versus myeloablative conditioning for allotransplantation of patients with lymphoma. Bone Marrow Transplant 2009;43:237–244.

    Article  CAS  Google Scholar 

  8. Coy DL, Ormazabal A, Godwin JD, Lalani T. Imaging evaluation of pulmonary and abdominal complications following hematopoietic stem cell transplantation. Radiographics 2005;25:305–317.

    Article  Google Scholar 

  9. Tomblyn M, Chiller T, Einsele H. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients:a global perspective. Biol Blood Marrow Transplant 2009; 15:1143.

    Article  CAS  Google Scholar 

  10. Soubani AO, Pandya CM. The spectrum of noninfectious pulmonary complications following hematopoietic stem cell transplantation. Hematol Oncol Stem Cell Ther 2010;3:143–157.

    Article  Google Scholar 

  11. Yen KT, Lee AS, Krowka MJ, Burger CD. Pulmonary complications in bone marrow transplantation:a practical approach to diagnosis and treatment. Clin Chest Med 2004;25:189–201.

    Article  Google Scholar 

  12. Gratwohl A, Baldomero H, Aljurf M, Pasquini MC, Bouzas LF, Yoshimi A. Hematopoietic stem cell transplantation:a global perspective. JAMA 2010;303:1617–1624.

    Article  CAS  Google Scholar 

  13. Ljungman P. The role of cytomegalovirus serostatus on outcome of hematopoietic stem cell transplantation. Curr Opin Hematol 2014;21:466–469.

    Article  CAS  Google Scholar 

  14. De Castro N, Neuville S, Sarfati C. Occurrence of Pneumocystis jiroveci pneumonia after allogeneic stem cell transplantation:a 6-year retrospective study. Bone Marrow Transplant 2005;36:879–883.

    Article  Google Scholar 

  15. Dizdar OS, Ersoy A, Akalin H. Pneumonia after kidney transplant:incidence, risk factors, and mortality. Exp Clin Transplant 2014;12:205–211.

    PubMed  Google Scholar 

  16. Afessa B, Tefferi A, Litzow MR, Krowka MJ, Wylam ME, Peters SG. Diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients. Am J Respir Crit Care Med 2002;166:641–645.

    Article  Google Scholar 

  17. Borhani AA, Hosseinzadeh K, Almusa O, Furlan A, Nalesnik M. Imaging of post-transplantation lymphoproliferative disorder after solid organ transplantation. Radiographics 2009;29:981–1002.

    Article  Google Scholar 

  18. Roychowdhury M, Pambuccian SE. Pulmonary complications after bone marrow transplantation. An autopsy study from a large transplantation center. Arch Pathol Lab Med 2005;129:366–371.

    PubMed  Google Scholar 

  19. Lucena CM, Torres A, Rovira M, Marcos MA. Pulmonary complications in hematopoietic SCT:a prospective study. Bone Marrow Transplant 2014;49:1293–1299.

    Article  CAS  Google Scholar 

  20. Afessa B, Abdulai RM, Kremers WK, Hogan WJ, Litzow MR, Peters SG. Risk factors and outcome of pulmonary complications after autologous hematopoietic stem cell transplant. Chest 2012;141:442–450.

    Article  Google Scholar 

  21. Diab M, ZazaDitYafawi J, Soubani AO. Major pulmonary complications after hematopoietic stem cell transplant. Exp Clin Transplant 2016;3:259–270.

    Google Scholar 

  22. Lim DH, Lee1 J, Lee HG, Park BB, Peck KR. Pulmonary complications after hematopoietic stemcell transplantation. J KoreanMed Sci 2006;21:406–411.

    Article  Google Scholar 

  23. Sahin U, Toprak SK, Atilla PA, Atilla E, Demirer T. An overview of infectious complications after allogeneic hematopoietic stem cell transplantation. J Infect Chemother 2016;22:505–519.

    Article  Google Scholar 

  24. Zaza Dit Yafawi J, Shehada E, Soubani AO. Pulmonary complications following hematopoietic stem cell transplantation. In:Montgomery WG, Burton HI, editors. Hematopoietic stem cells:new research. New York, NY:Nova Publishers; 2012. pp. 1–49.

    Google Scholar 

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Authors and Affiliations

  1. Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Zagazig University, 44511, Zagazig, Egypt

    Amal Abd El-Azem Sadon MD

  2. Department of Tropical, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Mohamed A. Saraya

  3. Department of Internal Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Rehab S. El-Hagrasy

Authors
  1. Amal Abd El-Azem Sadon MD
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  2. Rehab S. El-Hagrasy
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  3. Mohamed A. Saraya
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Corresponding author

Correspondence to Amal Abd El-Azem Sadon MD.

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Sadon, A.A.EA., El-Hagrasy, R.S. & Saraya, M.A. Pulmonary complications within the first year after bone marrow transplantation. Egypt J Bronchol 12, 233–239 (2018). https://doi.org/10.4103/ejb.ejb_33_17

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  • DOI: https://doi.org/10.4103/ejb.ejb_33_17

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