Lung complications after allogenic bone marrow transplantation

Jegal, Yang Jin; Lee, Je Hwan; Lee, Kyoo Hyung; Kim, Woo Kun; Shim, Tae Sun; Lim, Chae Man; Koh, Youn Suck; Lee, Sang Do; Kim, Woo Sung; Kim, Won Dong; Kim, Dong Soon

Abstract

BACKGROUND
The occurrence of lung complications after allogenic bone marrow transplantation(BMT) has been reported as 40-60 percent. The risk factors for lung complications are whole body irradiation, high dose chemotherapy, graft versus host disease, old age and CMV infection. The prevalence of graft versus host disease is less in Korea than in Western countries, but frequency of CMV infection is higher. Therefore, the pattern of lung complications may be different in Korea from those in Western countries.
METHODS
A retrospective cohort study was performed on one hundred consecutive adult patients who underwent allogenic bone marrow transplantation from December, 1993 to May, 1999 at Asan Medical Center. Lung complications were divided into two groups by the time of development, within 30days (pre-engraftment) and beyond 30 days (post-engraftment), and then subdivided into infectious and non-infectious complication. Infectious complications were defined as having the organism in blood, BAL fluid, pleural fluid or sputum, or compatible clinical findings in patients, which improved with antibiotics or an anti-fungal therapy. RESULT: 1) Eighty three episodes of lung complications had occurred in 54 patients. 2) Within thirty days after BMT, non-infectious complications were more common than infetions, but this pattern was reversed after 30days. After one year post-BMT, there was no infectious complication except in cases of recurrence of underlying disease or development of chronic GVHD. 3) Among the non-infectious complication, pleural effusion (27 episodes) was most common, followed by pulmonary edema(8 episodes), bronchiolitis obliterans(2 episodes), diffuse alveolar hemorrhage(1 episode) and bronchiloitis obliterans with organizing pneumonia(1 episode), 4) The infectious complications were pneumonia(bacterial:9 episodes, viral:4 episodes, fungal:5 episodes, pneumocystis carinii:1 episode), pulmonary tubercoulosis(3 episodes) and tuberculous pleurisy(3 episodes). 5) Lung complications were more frequent in CMV positive patients and in patients with delayed recovery of neutrophil count. 6) The mortality was higher in the patients with lung complications.
CONCLUSION
Lung complications developed in 54% after allogenic BMT and were associated with higher mortality.