Small-airways disease in recipients of allogeneic bone marrow transplants. An analysis of 11 cases and a review of the literature.
In a retrospective review of 116 consecutive allogeneic bone marrow transplants (BMT), severe obstructive airways disease was identified in 11 patients. Lung pathology demonstrated bronchiolitis in 9 patients and physiologic studies showed small-airways disease consistent with bronchiolitis in the other 2. None of the 5 patients with associated infection survived, while 3 of the 6 patients without an identified pathogen stabilized or improved. Analysis of the 11 cases presented and all 25 cases reported in the literature (1982 to 1985) supports the conclusion that graft-versus-host disease is a major risk factor for bronchiolitis in BMT recipients. Among the proposed mechanisms for the development of bronchiolitis after allogeneic BMT, the 2 most likely are graft-versus-host disease directly causing bronchiolitis, and increased immunosuppressive therapy given for graft-versus-host disease predisposing to viral bronchiolitis. The available evidence would suggest that it is prudent to obtain serial pulmonary function tests even in asymptomatic patients post-BMT, and particularly in those with chronic graft-versus-host disease, in the hope that early detection will allow for early intervention that will arrest or reverse the progression of the obstructive airways disease.
Chan
C K
CK
Hyland
R H
RH
Hutcheon
M A
MA
Minden
M D
MD
Alexander
M A
MA
Kossakowska
A E
AE
Urbanski
S J
SJ
Fyles
G M
GM
Fraser
I M
IM
Curtis
J E
JE
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy; D016026:Bone Marrow Transplantation; D001990:Bronchiolitis, Viral / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality* / Q000473:pathology; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008171:Lung Diseases / Q000209:etiology / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis