J Korean Med Sci.  2010 May;25(5):658-662. 10.3346/jkms.2010.25.5.658.

Thoracic Air-leak Syndromes In Hematopoietic Stem Cell Transplant Recipients with Graft-versus-Host Disease: A Possible Sign for Poor Response to Treatment and Poor Prognosis

• Moon MH
• Sa YJ
• Cho KD
• Jo KH
• Lee SH
• Sim SB

• KMID: 1713946
• DOI: http://doi.org/10.3346/jkms.2010.25.5.658

Abstract

Bronchiolitis obliterans (BO) or bronchiolitis obliterans organizing pneumonia (BOOP) is one of manifestations of graft-versus-host disease (GVHD), a complication of hematopoietic stem cell transplantation (HSCT). Recently there are reports about thoracic air-leakage syndrome (TALS), but real incidence, clinical course, and implications of TALS remain unclear. Retrospective review of 18 TALS patients among 2,177 patients who received allogeneic HSCT between January 2000 to July 2007 was done. Clinical manifestations, treatments, and outcomes of TALS were reviewed. The incidence of TALS was 0.83% (18/2,177). The onset of TALS was mean 425.9+/-417.8 days (60-1,825 days) after HSCT, and the duration was mean 16.3+/-21 days (2-90 days). The most common types of TALS were spontaneous pneumothroax (n=14), followed by subcutaneous emphysema (n=6), pneumomediastinum (n=5), interstitial emphysema (n=2), and pneumopericardium (n=1). TALS persisted in six patients, who died during the same hospitalization. The 12 patients recovered from TALS, but only 2 survived, while others died due to aggravation of GVHD. TALS may complicate BO/BOOP and be an initial manifestation of BO/BOOP. TALS is hard to be resolved, and even after the recovery, patients die because of aggravation of GVHD. We suggest specifically in HSCT patients, when once developed, TALS seems hard to be cured, and as a result, be related to high fatality.

Keyword

Pleural Diseases; Bronchiolitis Obliterans; Hematopoietic Stem Cell Transplantation; Graft vs Host Disease

MeSH Terms

Adolescent
Adult
Comorbidity
Female
Graft vs Host Disease/*mortality/*surgery
Hematopoietic Stem Cell Transplantation/*mortality
Hemothorax/*mortality
Humans
Incidence
Korea
Male
Middle Aged
Pneumothorax/*mortality
Prognosis
Risk Assessment
Risk Factors
Survival Analysis
Survival Rate
Syndrome
Treatment Outcome
Young Adult

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