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Diffuse Alveolar Hemorrhage in Hematopoietic Stem Cell Transplant Recipients

2002; American Thoracic Society; Volume: 166; Issue: 5 Linguagem: Inglês

10.1164/rccm.200112-141cc

1535-4970

Bekele Afessa, Ayalew Tefferi, Mark R. Litzow, Michael J. Krowka, Mark E. Wylam, Steve G. Peters,

Polyomavirus and related diseases

Hematopoietic stem cell transplantation (HSCT) is used for the INCIDENCE treatment of hematologic and solid tumors as well as for various The frequency of DAH has varied among reported series bebenign diseases worldwide. The International Bone Marrow cause of differences in patient mix, diagnostic approaches, and Transplant and the Autologous Blood and Marrow Transplant diagnostic criteria. The factors that influence the incidence of Registries estimate that approximately 50,000 hematopoietic DAH have changed over time and varied among HSCT centers. stem cell transplants were performed in 1998. Approximately Although bronchoscopy and surgical lung biopsy have been used 17,000 of these were allogeneic, and over 30,000 were autologous. for decades, their application in HSCT recipients with pulmonary Pulmonary complications develop in 30 to 60% of HSCT recipiinfiltrates has not been well standardized. Because underlying ents (1, 2). Because of graft-versus-host disease and immunosupconditions may prohibit invasive procedures, some clinicians pressant medications, both infectious and noninfectious pulmoprefer to initiate empiric antibiotics for suspected infection leadnary complications are more common in allogeneic than in ing to underdiagnosis of DAH. Moreover, although BAL is autologous HSCT recipients. Compared with bone marrow, the widely used for the diagnosis of DAH, the diagnostic criteria use of peripheral blood as the source of stem cells may lead to have elements of subjectivity and are not uniformly applied. fewer infectious pulmonary complications and bleeding during In seven studies that included 3,806 HSCT recipients, 204 the early post-HSCT period because of its association with a cases of DAH were reported, for a frequency of 5%, with a shorter neutrophil and platelet recovery time (3). The late-onset range between 2% and 14% (8–14). The reported frequency of noninfectious pulmonary complications have been addressed in DAH varies from 1 to 21% in autologous and from 2 to 17% a recent publication (4). Although alveolar hemorrhage can be in allogeneic HSCT recipients (1, 2, 5, 9–12, 15–22). DAH has caused by infections, diffuse alveolar hemorrhage (DAH) is conbeen reported in 123 of 2,616 (5%) autologous and 91 of 1,748 sidered to be a noninfectious pulmonary complication that usu(5%) allogeneic HSCT recipients (1, 2, 5, 9–12, 15–22). The ally occurs in the early posttransplant period. This commentary recent increase in the incidence of DAH has not been associated focuses on the frequency, risk factors, pathogenesis, clinical manwith uses of granulocyte colony-stimulating factor and peripheral ifestation, treatment, and prognosis of DAH. blood stem cell source (10).