Respiratory failure in the hematopoietic stem cell transplant recipient

Abstract

The number of patients receiving hematopoietic stem cell transplantation (HSCT) is rapidly rising worldwide. Despite substantial improvements in peri-transplant care, pulmonary complications resulting in respiratory failure remain a major contributor to morbidity and mortality in the post-transplant period, and represent a major barrier to the overall success of HSCT. Infectious complications include pneumonia due to bacteria, viruses, and fungi, and most commonly occur during neutropenia in the early post-transplant period. Non-infectious complications include idiopathic pneumonia syndrome, peri-engraftment respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary veno-occlusive disease, delayed pulmonary toxicity syndrome, cryptogenic organizing pneumonia, bronchiolitis obliterans syndrome, and post-transplant lymphoproliferative disorder. These complications have distinct clinical features and risk factors, occur at differing times following transplant, and contribute to morbidity and mortality.

Keywords: Hematopoietic stem cell transplantation; Immunocompromised host; Pulmonary complications; Respiratory failure; Stem cell transplant.

Figure 1

Time-course of pulmonary complications following hematopoietic stem cell transplantation. BOS: Bronchiolitis obliterans syndrome; CARV: Community-acquired respiratory viruses; CMV: Cytomegalovirus; COP: Cryptogenic organizing pneumonia; DAH: Diffuse alveolar hemorrhage; DPTS: Delayed pulmonary toxicity syndrome; HSV: Herpes simplex virus; IPS: Idiopathic pneumonia syndrome; PERDS: Peri-engraftment respiratory distress syndrome; PTLD: Post-transplant lymphoproliferative disorder; PVOD: Pulmonary veno-occlusive disease.