title: Small-airways disease in recipients of allogeneic bone marrow transplants. An analysis of 11 cases and a review of the literature.
abstract: 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.
authors.forename: C K
authors.initials: CK
authors.lastname: Chan
authors.forename: R H
authors.initials: RH
authors.lastname: Hyland
authors.forename: M A
authors.initials: MA
authors.lastname: Hutcheon
authors.forename: M D
authors.initials: MD
authors.lastname: Minden
authors.forename: M A
authors.initials: MA
authors.lastname: Alexander
authors.forename: A E
authors.initials: AE
authors.lastname: Kossakowska
authors.forename: S J
authors.initials: SJ
authors.lastname: Urbanski
authors.forename: G M
authors.initials: GM
authors.lastname: Fyles
authors.forename: I M
authors.initials: IM
authors.lastname: Fraser
authors.forename: J E
authors.initials: JE
authors.lastname: Curtis
mesh_terms: 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