Diffuse pulmonary infiltrates after bone marrow transplantation: the role of open lung biopsy.
BACKGROUND
Diffuse pulmonary infiltrates is the major complication and cause of mortality after bone marrow transplantation. We analyzed the etiologies and prognostic factors in bone marrow recipients with diffuse pulmonary infiltrates and assessed the role of open lung biopsy in managing this complication.


METHODS
Medical records of patients with diffuse pulmonary infiltrates after bone marrow transplantation were reviewed. Possible prognostic factors were analyzed by multivariate logistic regression.


RESULTS
Sixty-eight (20%) of 341 bone marrow recipients had diffuse pulmonary infiltrates and 34 died. Thirty-five underwent open lung biopsy, resulting in therapeutic changes in 22 (63%) and clinical improvement in 16 (46%). The leading diagnoses were idiopathic interstitial pneumonitis (40%) and cytomegalovirus pneumonitis (20%). Cytomegalovirus pneumonitis caused radiographically observable interstitial infiltrates exclusively and was frequently associated with hepatitis. Idiopathic interstitial pneumonitis resulted in either diffuse ground-glass opacity or interstitial infiltrates. Three (9%) patients had miliary tuberculosis. Respiratory failure (p < 0.001) and acute graft-versus-host disease (p = 0.016) were the poor prognostic factors.


CONCLUSIONS
Among bone marrow recipients, we found diffuse pulmonary infiltrates in 20% and a mortality rate of 50%. Idiopathic interstitial pneumonitis and cytomegalovirus pneumonitis were the most common causes and should be suspected in patients with diffuse interstitial infiltrates. In endemic areas, miliary tuberculosis should be suspected in bone marrow recipients with diffuse reticulonodular lesions. Respiratory failure and acute graft-versus-host disease were poor prognostic factors. By establishing a correct diagnosis, open lung biopsy led to treatment changes in about two-thirds of these patients.
Wang
Jann-Yuan
JY
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chang
Yih-Leong
YL
Lee
Li-Na
LN
Chen
Jen-Hau
JH
Tang
Jih-Luh
JL
Yang
Pan-Chyr
PC
Lee
Yung-Chie
YC
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006402:Hematologic Diseases / Q000628:therapy; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D014391:Tuberculosis, Miliary / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*