Idiopathic Pneumonia Syndrome and Respiratory Failure After Marrow Transplantation

Abstract

Historically, pulmonary disease occurs in 40 to 60% of patients after marrow transplantation. Now, the sources of donor stem cells to serve as a marrow graft have expanded from autologous and sibling (allogeneic) bone marrow to include a pool of unrelated marrow donors, fetal cord blood, and growth factor-stimulated peripheral blood. It is unclear whether the use of these alternative hematopoietic precursors will alter the incidence of pulmonary complications. It is likely that lung injury, especially that associated with intensive chemo-irradiation therapy, will continue. Recently, the spectrum of idiopathic lung injury has been recognized as a syndrome (idiopathic pneumonia syndrome, IPS). The diagnosis of IPS is defined by a bronchoalveolar lavage that does not reveal an infection, in the presence of nonlobar radiographic infiltrates, and physiological changes consistent with pneumonia. Data suggest that the majority of these cases progress to respiratory failure and multiorgan failure that carries a significant mortality. With present life-support and treatment, the combination of severe lung injury with either significant hepatorenal insufficiency or hypotension appears uniformly fatal.