Noninfectious pulmonary complications of haematopoietic stem cell transplantation

Abstract

Haematopoietic stem cell transplantation (HSCT) is an established treatment for a variety of malignant and nonmalignant conditions. Pulmonary complications, both infectious and noninfectious, are a major cause of morbidity and mortality in patients who undergo HSCT. Recent advances in prophylaxis and treatment of infectious complications has increased the significance of noninfectious pulmonary conditions. Acute lung injury associated with idiopathic pneumonia syndrome remains a major acute complication with high morbidity and mortality. On the other hand, bronchiolitis obliterans syndrome is the most challenging chronic pulmonary complication facing clinicians who are taking care of allogeneic HSCT recipients. Other noninfectious pulmonary complications following HSCT are less frequent. This review provides a clinical update of the incidence, risk factors, pathogenesis, clinical characteristics and management of the main noninfectious pulmonary complications following HSCT.

FIGURE 1

Chest computed tomography image of a patient with diffuse alveolar haemorrhage showing bilateral consolidative and ground-glass changes.

FIGURE 2

High-resolution chest computed tomography image of a patient with bronchiolitis obliterans syndrome showing mosaic pattern.

FIGURE 3

Chest computed tomography image of a patient with pulmonary fibrosis and air leak syndrome.

FIGURE 4

Algorithm of the initial diagnostic approach to haematopoietic stem cell transplantation (HSCT) patients presenting with new respiratory symptoms. HRCT: high-resolution computed tomography; BAL: bronchoalveolar lavage; PERDS: peri-engraftment respiratory distress syndrome; DAH: diffuse alveolar haemorrhage; COP: cryptogenic organising pneumonia; AIP: acute interstitial pneumonitis; ARDS: acute respiratory distress syndrome; PFT: pulmonary function test. ^#: spirometry showing forced expiratory volume/forced vital capacity <0.7 and decrease in forced expiratory volume in 1 s ≥10% from baseline. ^¶: decline in total lung capacity ≥10% from baseline. ⁺: persistent multilobar opacities (ground-glass, consolidation, small linear and reticular) with increasing pleural thickening consistent with pulmonary and/or pleural fibrosis.