Yeungnam Univ J Med.  2015 Dec;32(2):98-101. 10.12701/yujm.2015.32.2.98.

Pumpless extracorporeal interventional lung assist for bronchiolitis obliterans after allogenic peripheral blood stem cell transplantation for acute lymphocytic leukemia

• Park YH
• Chung CU
• Choi JW
• Jung SO
• Jung SS
• Lee JE
• Kim JO
• Moon JY

• KMID: 2319907
• DOI: http://doi.org/10.12701/yujm.2015.32.2.98

Abstract

Bronchiolitis obliterans (BO), which is associated with graft-versus-host disease after allogenic hematopoietic stem cell transplantation, is a major obstacle to survival after bone marrow transplantation due to its gradual progress, eventually leading to respiratory failure. Pumpless extracorporeal interventional lung assist (iLA) is effective in treatment of reversible hypercapnic respiratory failure. In this paper, we present a 23-year-old female patient who underwent allogeneic peripheral blood stem cell transplantation (PBSCT) for acute lymphocytic leukemia. After 6 months, she complained of shortness of breath and was diagnosed with BO. Five months later, she developed an upper respiratory tract infection that worsened her BO and caused life-threatening hypercapnia. Since mechanical ventilation failed to eliminate CO2 effectively, iLA was applied as rescue therapy. Her hypercapnia and respiratory acidosis showed significant improvement within a few hours, and she was successfully weaned off iLA after 12 days. This is the first case report of iLA application for temporarily aggravated hypercapnia of PBSCT-associated BO followed by successful weaning. This rescue therapy should be considered in ventilator-refractory reversible hypercapnia in BO patients.

Keyword

Bronchiolitis obliterans; Graft vs host disease; Pumpless extracorporeal interventional lung assist; Hypercapnia

MeSH Terms

Acidosis, Respiratory
Bone Marrow Transplantation
Bronchiolitis Obliterans*
Bronchiolitis*
Dyspnea
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Hypercapnia
Lung*
Peripheral Blood Stem Cell Transplantation*
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
Respiration, Artificial
Respiratory Insufficiency
Respiratory Tract Infections
Weaning
Young Adult