Diffuse Alveolar Hemorrhage in Hematopoietic Stem Cell Transplant Recipients and Patients with Hematologic Malignancy

Abstract

Diffuse alveolar hemorrhage (DAH) is characterized by diffuse pulmonary infiltrates on chest radiograph, hypoxemia, progressively bloodier return, or ≥20% hemosiderin-laden macrophages of bronchoalveolar lavage fluid, and the absence of cardiac or infectious causes. The incidence, clinical course, treatment, and prognosis of DAH in patients with hematologic malignancy, but without blood and marrow transplantation (BMT) have not been well described. DAH develops in approximately 4.4% of BMT recipients. Pre-transplant intensive chemotherapy, myeloablative conditioning regimen, total body irradiation, thoracic irradiation, and old age are risk factors for DAH in BMT recipients. The incidence of DAH does not differ between autologous and allogeneic recipients. Although the pathogenesis of DAH in the BMT recipient has not been clearly established, lung tissue injury, inflammation, and cytokine release are implicated. The onset of DAH is usually within the first 30 days following BMT, and the symptoms and findings include progressive dyspnea, cough, fever, hypoxemia, and diffuse consolidation on chest radiograph. Hemoptysis is uncommon. BMT recipients with DAH are often treated with high-dose corticosteroids. The majority of them receive invasive mechanical ventilation. The overall reported mortality rate of BMT recipients with DAH is 76%.