Marrow engraftment and clinical manifestations of capillary leak syndrome.
A capillary leak syndrome occurs frequently in bone marrow transplant patients in addition to graft-versus-host-disease and infection. The underlying pathology is poorly understood but the clinical manifestations of excessive weight gain, ascites, and edema associated with kidney and liver abnormalities suggest a common injury to multiple organs. The clinical courses of 55 allogeneic and autologous marrow transplant recipients were retrospectively reviewed with regard to the presentation of a capillary leak syndrome (CLS). Twenty-nine patients (53%) developed non-cardiogenic pulmonary edema with or without concurrent pleural effusions; the incidence was comparable in allogeneic and autologous recipients. Pulmonary features were accompanied by hepatic dysfunction in 28, renal dysfunction in 22, and central nervous system abnormalities in 17. There was a strong correlation between time of engraftment and the first manifestations of CLS, both of which occurred earlier in allogeneic than in autologous transplant recipients. These data confirm that CLS occurs in both allogeneic and autologous transplant recipients and suggest a pivotal contribution by circulating leukocytes.
Cahill
R A
RA
Naval Medical Research Institute, National Naval Medical Center, Bethesda, MD, USA.
Spitzer
T R
TR
Mazumder
A
A
D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D019559:Capillary Leak Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000293:injuries* / Q000503:physiopathology; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007239:Infections / Q000150:complications; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology; D007962:Leukocytes / Q000276:immunology / Q000378:metabolism; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology; D008222:Lymphokines / Q000378:metabolism; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology; D011654:Pulmonary Edema / Q000453:epidemiology / Q000209:etiology; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents; D008222:Lymphokines