Pulmonary complications of bone marrow transplantation

Mayo Clinic College of Medicine, Rochester, Minnesota, U.S.A. 

Tens of thousands of patients undergo blood and marrow transplantation (BMT) annually, primarily for hematologic malignancies. Since both their innate and acquired immune systems are impaired, infectious and noninfectious complications occur frequently in BMT recipients. The recovery of the immune system following BMT depends on the underlying disorder, stem cell source, and complications such as graft versus host disease (GVHD). Pulmonary complications develop in 25% to 60% of BMT recipients and are the immediate cause of death in approximately 61% (1). The main pulmonary complications are listed in Table 1. 

The posttransplant period is divided into three phases preengraftment (0 to 30 days), early postengraftment (30-100 days) and late posttransplant ( 100 days). The pulmonary complications follow characteristic time patterns (2). Although infections may present as diffuse pulmonary or bronchiolar disorders, this chapter will focus on noninfectious complications. Among the noninfectious pulmonary complications, pulmonary edema, diffuse alveolar hemorrhage (DAH) and periengraftment respiratory distress syndrome (PERDS) usually occur during 

Acute pulmonary edema Diffuse alveolar hemorrhage Periengraftment respiratory distress syndrome Bronchiolitis obliterans syndrome Bronchiolitis obliterans organizing pneumonia Idiopathic pulmonary syndrome Delayed pulmonary toxicity syndrome Pulmonary cytolytic thrombi Pulmonary veno-occlusive disease Progressive pulmonary fibrosis Pulmonary hypertension Hepatopuhnonary S3mdrome Pulmonary alveolar proteinosis Eosinophilic pneumonia 

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Woodard JP, Gulbahce E, Shreve M, et al. Pulmonary cytolytic thromhi a newly recognized complication of stem cell transplantation. Bone Marrow Transplant 2000 25(3) 293-300. 

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