Pulmonary complications after autologous hematopoietic cell transplantation
- Robert J Kaner, MD
Robert J Kaner, MD
- Associate Professor of Clinical Medicine
- Weill Medical College of Cornell University
- Dana Zappetti, MD
Dana Zappetti, MD
- Assistant Professor of Medicine
- Weill Cornell Medical College
- Section Editors
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
- Robert S Negrin, MD
Robert S Negrin, MD
- Section Editor — Bone Marrow Transplantation
- Professor of Medicine
- Stanford University School of Medicine
Autologous hematopoietic cell transplantation is performed with increasing frequency, particularly as salvage therapy after high dose chemotherapy for recurrent lymphoma, leukemia, multiple myeloma, germ cell tumors, and neuroblastoma. A variety of pulmonary complications have been described with these procedures, occurring either early (within the first 30 days or pre-engraftment) or late (more than one month or post-engraftment) after transplantation. This distinction can guide the differential diagnosis and clinical evaluation of these disorders.
The term "hematopoietic cell transplantation" (HCT) will be used throughout this review as a general term to cover transplantation of progenitor cells from any source (eg, bone marrow, peripheral blood, umbilical cord blood). Otherwise, the source of such cells will be specified (eg, autologous peripheral blood progenitor cell transplantation). (See "Sources of hematopoietic stem cells".)
Significant pulmonary complications are a leading cause of morbidity and mortality following HCT . The pulmonary complications of autologous HCT will be reviewed here. The pulmonary complications of allogeneic HCT are discussed separately. (See "Pulmonary complications after allogeneic hematopoietic cell transplantation".)
TECHNIQUE OF AUTOLOGOUS HCT
Autologous HCT refers to collection of hematopoietic progenitor cells from the patient prior to the administration of high dose chemotherapy designed to target an underlying malignancy, followed by reinfusion of these cells. In the past, autologous bone marrow was obtained from the patient by multiple iliac crest aspirations under general anesthesia. However, most transplant centers now exclusively utilize peripheral blood progenitor cells (PBPCs) mobilized by hematopoietic growth factor administration for autologous transplantation. The cells are collected by leukapheresis, avoiding the need for general anesthesia. (See "Sources of hematopoietic stem cells".)
COMPARISON WITH ALLOGENEIC HCT
The pulmonary complications of autologous HCT share many of the features associated with allogeneic HCT, but there are also important differences. (See "Pulmonary complications after allogeneic hematopoietic cell transplantation".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- TECHNIQUE OF AUTOLOGOUS HCT
- COMPARISON WITH ALLOGENEIC HCT
- APPROACH TO THE PATIENT WITH RESPIRATORY SYMPTOMS OR SIGNS
- EARLY COMPLICATIONS
- Pre-engraftment respiratory infections
- Pulmonary edema
- Engraftment syndrome and PERDS
- Diffuse alveolar hemorrhage
- LATE COMPLICATIONS
- Respiratory infections
- Abnormal pulmonary function tests
- Idiopathic pneumonia syndrome
- Toxicity from chemotherapy and/or radiotherapy
- Bronchiolitis obliterans
- Cardiac and pulmonary vascular
- PREDICTING COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS