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Review
. 2017 Mar;38(1):97-111.
doi: 10.1016/j.ccm.2016.11.002. Epub 2016 Dec 16.

Viral Pneumonia in Patients with Hematologic Malignancy or Hematopoietic Stem Cell Transplantation

Erik Vakil  1 , Scott E Evans  2
Affiliations
Review

Viral Pneumonia in Patients with Hematologic Malignancy or Hematopoietic Stem Cell Transplantation

Erik Vakil et al. Clin Chest Med. 2017 Mar.

Abstract

Viral pneumonias in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation cause significant morbidity and mortality. Advances in diagnostic techniques have enabled rapid identification of respiratory viral pathogens from upper and lower respiratory tract samples. Lymphopenia, myeloablative and T-cell depleting chemotherapy, graft-versus-host disease, and other factors increase the risk of developing life-threatening viral pneumonia. Chest imaging is often nonspecific but may aid in diagnoses. Bronchoscopy with bronchoalveolar lavage is recommended in those at high risk for viral pneumonia who have new infiltrates on chest imaging.

Keywords: Hematologic malignancy; Immunocompromised host pneumonia; Stem cell transplant; Viral pneumonia.

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Figures

Fig. 1
Fig. 1
Algorithmic approach to the HM/HSCT patient with suspected viral infection. ID consult, consultation with infectious disease expert; PCR Panel, PCR-base viral nucleic acid detection panel. a High-risk patient characteristics: lymphopenia, neutropenia, active GVHD, T-cell–depleting regimens, myeloablative conditioning, high-dose corticosteroids, age >65 years, hypoalbuminemia.
Fig. 2
Fig. 2
Radiographic presentations of BAL-documented viral pneumonia. (A) Mucus plugging and consolidative opacities in a patient with hMPV and multiple myeloma following autologous HSCT. (B) Mucus plugging and GGOs in a patient with RSV and acute myelogenous leukemia following allogeneic HSCT. (C) Bronchial wall thickening and consolidative opacities in a patient with rhinovirus and chronic lymphocytic leukemia following allogeneic HSCT. (D) Multifocal GGO and micronodules in a patient with PIV and acute myelogenous leukemia receiving clofarabine. (E) Focal consolidative opacity in a patient with influenza A and untreated acute myelogenous leukemia. (F) Diffuse GGOs and micronodules in a patient with CMV pneumonitis and acute myelogenous leukemia following matched-unrelated donor allogeneic HSCT.
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