Pulmonary complications in adult blood and marrow transplant recipients: Autopsy findings

Sunita Sharma, Hassan F. Nadrous, Steve G. Peters, Ayalew Tefferi, Mark R Litzow, Marie Christine Aubry, Bekele Afessa

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Study objective: To describe the pulmonary findings at autopsy of blood and bone marrow transplant (BMT) recipients. Design: Retrospective. Setting: An academic medical center. Patients: Seventy-one deceased adult BMT recipients. Interventions: None. Measurements: Antemortem and postmortem pulmonary findings. Results: The transplants were allogeneic in 39 patients (55%), with a peripheral stem cell source in 43 patients (61%). Death occurred at a median of 1.30 months after transplant. Ninety-six pulmonary complications were noted in 63 patients (89%); 27 infectious (bacterial bronchopneumonia, n = 13; pulmonary aspergillosis, n = 11; cytomegalovirus pneumonia, n = 2; and Candida bronchopneumonia, n = 1) and 69 noninfectious (diffuse alveolar damage, n = 35; diffuse alveolar hemorrhage [DAH], n = 10; amyloidosis, n = 9; pulmonary embolism, n = 5; lymphoma/leukemia, n = 4; bronchiolitis obliterans, n = 2; bronchiolitis obliterans organizing pneumonia, n = 1; pulmonary alveolar proteinosis, n = 1; aspiration pneumonia, n = 1; and acute and organizing pneumonia, n = 1). Twenty-seven of the 96 complications (28%) were diagnosed antemortem. Infectious complications were more likely to be diagnosed antemortem compared to noninfectious complications (48% vs 20%, p = 0.006). Six of the 13 patients with bronchopneumonia (46%), 5 of the 11 patients with pulmonary aspergillosis (45%), and 7 of the 8 patients with DAH (88%) at autopsy were not receiving treatment for these conditions at the time of death. Ten patients being treated for suspected pulmonary aspergillosis, 7 patients treated for suspected pulmonary cytomegalovirus infection, 22 patients treated for suspected bacterial pneumonia, 2 patients treated for suspected Pneumocystis carinii pneumonia, and 12 patients treated for DAH at the time of death had no evidence of these conditions at autopsy. The most common immediate cause of death was respiratory failure (n = 37, 52%). Conclusions: Pulmonary complications, the majority not diagnosed antemortem, are the most common cause of death in BMT recipients. As the result of underdiagnosis, BMT recipients may not receive appropriate therapy for potentially treatable pulmonary complications.

Original languageEnglish (US)
Pages (from-to)1385-1392
Number of pages8
JournalChest
Volume128
Issue number3
DOIs
StatePublished - Sep 2005

Fingerprint

Autopsy
Bone Marrow
Lung
Pulmonary Aspergillosis
Bronchopneumonia
Hemorrhage
Transplant Recipients
Cause of Death
Pneumonia
Pulmonary Alveolar Proteinosis
Cryptogenic Organizing Pneumonia
Bronchiolitis Obliterans
Transplants
Bacterial Pneumonia
Aspiration Pneumonia
Pneumocystis Pneumonia
Cytomegalovirus Infections
Amyloidosis
Cytomegalovirus
Pulmonary Embolism

Keywords

  • Aspergillosis
  • Autopsy
  • Bone marrow transplantation
  • Bronchiolitis obliterans
  • Bronchiolitis obliterans organizing pneumonia
  • Cause of death
  • Pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Pulmonary complications in adult blood and marrow transplant recipients : Autopsy findings. / Sharma, Sunita; Nadrous, Hassan F.; Peters, Steve G.; Tefferi, Ayalew; Litzow, Mark R; Aubry, Marie Christine; Afessa, Bekele.

In: Chest, Vol. 128, No. 3, 09.2005, p. 1385-1392.

Research output: Contribution to journalArticle

Sharma, Sunita ; Nadrous, Hassan F. ; Peters, Steve G. ; Tefferi, Ayalew ; Litzow, Mark R ; Aubry, Marie Christine ; Afessa, Bekele. / Pulmonary complications in adult blood and marrow transplant recipients : Autopsy findings. In: Chest. 2005 ; Vol. 128, No. 3. pp. 1385-1392.
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abstract = "Study objective: To describe the pulmonary findings at autopsy of blood and bone marrow transplant (BMT) recipients. Design: Retrospective. Setting: An academic medical center. Patients: Seventy-one deceased adult BMT recipients. Interventions: None. Measurements: Antemortem and postmortem pulmonary findings. Results: The transplants were allogeneic in 39 patients (55{\%}), with a peripheral stem cell source in 43 patients (61{\%}). Death occurred at a median of 1.30 months after transplant. Ninety-six pulmonary complications were noted in 63 patients (89{\%}); 27 infectious (bacterial bronchopneumonia, n = 13; pulmonary aspergillosis, n = 11; cytomegalovirus pneumonia, n = 2; and Candida bronchopneumonia, n = 1) and 69 noninfectious (diffuse alveolar damage, n = 35; diffuse alveolar hemorrhage [DAH], n = 10; amyloidosis, n = 9; pulmonary embolism, n = 5; lymphoma/leukemia, n = 4; bronchiolitis obliterans, n = 2; bronchiolitis obliterans organizing pneumonia, n = 1; pulmonary alveolar proteinosis, n = 1; aspiration pneumonia, n = 1; and acute and organizing pneumonia, n = 1). Twenty-seven of the 96 complications (28{\%}) were diagnosed antemortem. Infectious complications were more likely to be diagnosed antemortem compared to noninfectious complications (48{\%} vs 20{\%}, p = 0.006). Six of the 13 patients with bronchopneumonia (46{\%}), 5 of the 11 patients with pulmonary aspergillosis (45{\%}), and 7 of the 8 patients with DAH (88{\%}) at autopsy were not receiving treatment for these conditions at the time of death. Ten patients being treated for suspected pulmonary aspergillosis, 7 patients treated for suspected pulmonary cytomegalovirus infection, 22 patients treated for suspected bacterial pneumonia, 2 patients treated for suspected Pneumocystis carinii pneumonia, and 12 patients treated for DAH at the time of death had no evidence of these conditions at autopsy. The most common immediate cause of death was respiratory failure (n = 37, 52{\%}). Conclusions: Pulmonary complications, the majority not diagnosed antemortem, are the most common cause of death in BMT recipients. As the result of underdiagnosis, BMT recipients may not receive appropriate therapy for potentially treatable pulmonary complications.",
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AU - Litzow, Mark R

AU - Aubry, Marie Christine

AU - Afessa, Bekele

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N2 - Study objective: To describe the pulmonary findings at autopsy of blood and bone marrow transplant (BMT) recipients. Design: Retrospective. Setting: An academic medical center. Patients: Seventy-one deceased adult BMT recipients. Interventions: None. Measurements: Antemortem and postmortem pulmonary findings. Results: The transplants were allogeneic in 39 patients (55%), with a peripheral stem cell source in 43 patients (61%). Death occurred at a median of 1.30 months after transplant. Ninety-six pulmonary complications were noted in 63 patients (89%); 27 infectious (bacterial bronchopneumonia, n = 13; pulmonary aspergillosis, n = 11; cytomegalovirus pneumonia, n = 2; and Candida bronchopneumonia, n = 1) and 69 noninfectious (diffuse alveolar damage, n = 35; diffuse alveolar hemorrhage [DAH], n = 10; amyloidosis, n = 9; pulmonary embolism, n = 5; lymphoma/leukemia, n = 4; bronchiolitis obliterans, n = 2; bronchiolitis obliterans organizing pneumonia, n = 1; pulmonary alveolar proteinosis, n = 1; aspiration pneumonia, n = 1; and acute and organizing pneumonia, n = 1). Twenty-seven of the 96 complications (28%) were diagnosed antemortem. Infectious complications were more likely to be diagnosed antemortem compared to noninfectious complications (48% vs 20%, p = 0.006). Six of the 13 patients with bronchopneumonia (46%), 5 of the 11 patients with pulmonary aspergillosis (45%), and 7 of the 8 patients with DAH (88%) at autopsy were not receiving treatment for these conditions at the time of death. Ten patients being treated for suspected pulmonary aspergillosis, 7 patients treated for suspected pulmonary cytomegalovirus infection, 22 patients treated for suspected bacterial pneumonia, 2 patients treated for suspected Pneumocystis carinii pneumonia, and 12 patients treated for DAH at the time of death had no evidence of these conditions at autopsy. The most common immediate cause of death was respiratory failure (n = 37, 52%). Conclusions: Pulmonary complications, the majority not diagnosed antemortem, are the most common cause of death in BMT recipients. As the result of underdiagnosis, BMT recipients may not receive appropriate therapy for potentially treatable pulmonary complications.

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KW - Autopsy

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KW - Bronchiolitis obliterans organizing pneumonia

KW - Cause of death

KW - Pneumonia

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