title: A call to arms: a critical need for interventions to limit pulmonary toxicity in the stem cell transplantation patient population.
abstract: Noninfectious pulmonary toxicity after allogeneic hematopoietic stem cell transplantation (allo-HSCT) causes significant morbidity and mortality. Main presentations are idiopathic pneumonia syndrome (IPS) in the acute setting and bronchiolitis obliterans syndrome (BOS) and cryptogenic organizing pneumonia (COP) at later time point. While COP responds well to corticosteroids, IPS and BOS often are treatment refractory. IPS, in most cases, is rapidly fatal, whereas BOS progresses over time, resulting in chronic respiratory failure, impaired quality of life, and eventually, death. Standard second-line treatments are currently lacking, and current approaches, such as augmented T cell-directed immunosuppression, B cell depletion, TNF blockade, extracorporeal photopheresis, and tyroskine kinase inhibitor therapy, are unsatisfactory with responses in only a subset of patients. Better understanding of underlying pathophysiology hopefully results in the identification of future targets for preventive and therapeutic strategies along with an emphasis on currently underutilized rehabilitative and supportive measures.
authors: Division of Hematology and Hematologic Malignancies, University of Utah, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, 84112-5550, UT, USA, sabari.radhakrishnan@hci.utah.edu.
authors: Sabarinath Venniyil
authors: SV
authors: Radhakrishnan
authors: Gerhard C
authors: GC
authors: Hildebrandt
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016040:Lung Transplantation; D011014:Pneumonia / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011788:Quality of Life
chemical_list: D000900:Anti-Bacterial Agents; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D047428:Protein Kinase Inhibitors