Pulmonary complications in bone marrow transplantation: A practical approach to diagnosis and treatment

Kenneth T. Yen, Augustine S. Lee, Michael J. Krowka, Charles D. Burger

Research output: Contribution to journalReview article

63 Scopus citations

Abstract

Pulmonary complications occur in 40% to 60% of recipients of bone marrow transplants, account for more than 90% of mortality, and develop during identifiable phases. Phase 1 (Days 1-30) includes pulmonary edema; diffuse alveolar hemorrhage; and various bacterial, fungal, and viral infections; Phase 2 (Days 31-100) usually requires a distinction between cytomegalovirus pneumonitis and idiopathic pneumonia syndrome; and Phase 3 (Day 100+) includes complications that are due to chronic graft-versus-host disease and associated bronchiolitis obliterans. The spectrum of pulmonary complications has been influenced by changes in transplantation technique, prophylactic treatment for infections, and the use of new chemotherapeutic agents that contribute to lung injury. Nonetheless, infections remain a leading cause of morbidity and mortality. The most serious complications result in respiratory failure, for which the prognosis has not improved significantly over the last 2 decades. In this article, we describe our algorithmic approach to the diagnosis and management of these complications.

Original languageEnglish (US)
Pages (from-to)189-201
Number of pages13
JournalClinics in Chest Medicine
Volume25
Issue number1
DOIs
StatePublished - Mar 1 2004

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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