Airway disease in hematologic malignancies

Abstract

Introduction: Hematologic malignancies are cancers of the blood, bone marrow and lymph nodes and represent a heterogenous group of diseases that affect people of all ages. Treatment generally involves chemotherapeutic or targeted agents that aim to kill malignant cells. In some cases, hematopoietic stem cell transplantation (HCT) is required to replenish the killed blood and stem cells. Both disease and therapies are associated with pulmonary complications. As survivors live longer with the disease and are treated with novel agents that may result in secondary immunodeficiency, airway diseases and respiratory infections will increasingly be encountered. To prevent airways diseases from adding to the morbidity of survivors or leading to long-term mortality, improved understanding of the pathogenesis and treatment of viral bronchiolitis, BOS, and bronchiectasis is necessary.

Areas covered: This review focuses on viral bronchitis, BOS and bronchiectasis in people with hematological malignancy. Literature was reviewed from Pubmed for the areas covered.

Expert opinion: Airway disease impacts significantly on hematologic malignancies. Viral bronchiolitis, BOS and bronchiectasis are common respiratory manifestations in hematological malignancy. Strategies to identify patients early in their disease course may improve the efficacy of treatment and halt progression of lung function decline and improve quality of life.

Keywords: Hematologic malignancy; airway disease; bronchiectasis; bronchiolitis obliterans syndrome; graft versus host disease; viral bronchitis.

Figure 1:

CT Chest of a patient with pulmonary GVHD after HCT for AML. (right) Expiratory images demonstrate mosaicism secondary to air-trapping, (Left) Inspiratory images show bronchial wall thickening and early bronchiectasis.

Figure 2:

Cystic bronchiectasis with mucus

Figure 3:

Airway complications in hematologic malignancy post-allograft stem cell transplantation

Figure 4:

CT chest (left) demonstrates mild bronchiectasis in a patient with GVHD following HCT for AML - (A) Bronchial dilatation and bronchial wall thickness (B) bronchial dilatation without wall thickness. The CT Chest (right) demonstrates bronchiectasis with widespread tree-in-bud changes during influenza A infection due to small airway inflammation and mucus plugging.