Abstract
BackgroundMature blood cells can be differentiated from hematopoietic stem cells; thus, the latter can play a crucial role in maintaining defense against different microorganisms. Thus, hematopoietic stem cell transplantation is one of the most important lines of immunotherapy. Major systemic complications may occur post transplantation and could be fatal. Pulmonary complications include infectious and non-infectious complications. The aim of this study was to detect the pulmonary complications in allogeneic stem cell transplantation patients.ResultsWe studied 20 patients after transplantation of allogeneic stem cells with regular follow-up in outpatient clinic of hematology department of Alexandria Main University Hospital. All the studied patients were subjected to history taking, plain x-ray chest PA view, CT chest, complete blood count, serum creatinine, liver enzymes, and serum cytomegalovirus (CMV) detection by antibodies IgG and IgM. Regarding sputum sampling, 7 patients’ samples (35%) were obtained either spontaneously or by induction via hypertonic saline 3%. One patient (5%) had miniBAL done, while bronchoalveolar lavage using fiber optic bronchoscopy was done for 2 patients (10%). Samples could not be obtained from the remaining patients. Samples were analyzed for culture for bacteria, Pneumocystis jiroveci using immunofluorescence test, CMV PCR, fungal culture, and smear for acid fast bacilli (AFB). Among the examined patients, 2 patients (20%) had pulmonary bacterial infection including streptococcus and multidrug-resistant strain of Klebsiella, 3 patients (30%) had pulmonary candida infection, and one patient (10%) had positive result of pulmonary CMV of low count which was considered insignificant. None of our patients had positive results for pulmonary tuberculosis nor Pneumocystis jiroveci. Six patients (30%) had CMV in serum; 3 patients (15.8%) had manifested CMV reactivation. One patient (5%) of our patients had pulmonary graft versus host disease GVHD. One patient (5%) had died during our study course within 12 days post-transplantation due to ARDS followed by multiple organ failure.ConclusionThe prevalence of pulmonary infectious complications after allogenic stem cell transplantation was 50% of all studied patients, while 5% of the studied patients presented with non-infectious pulmonary complications.
Highlights
Mature blood cells can be differentiated from hematopoietic stem cells; the latter can play a crucial role in maintaining defense against different microorganisms
Spontaneous sputum was obtained from 1 patient (10%), 6 patients (60%) had induced sputum by hypertonic saline, fiber optic bronchoscopy was performed to 2 patients (20%), and one patient (10%) had Mini-bronchial alveolar lavage (miniBAL) done
Bacterial pulmonary infections were detected in two patients in our study, the causative agents were Streptococcus pneumoniae and Multidrug resistance (MDR) Klebsiella, while three patients had candida as fungal infections; these infections were predisposed by effect of conditioning regimen on immune system
Summary
Mature blood cells can be differentiated from hematopoietic stem cells; the latter can play a crucial role in maintaining defense against different microorganisms. Hematopoietic stem cell transplantation is one of the most important lines of immunotherapy. Pulmonary complications include infectious and non-infectious complications. The aim of this study was to detect the pulmonary complications in allogeneic stem cell transplantation patients. Hematopoietic stem cell transplantation (HSCT) takes place when a recipient’s stem cells are eradicated either by hematological malignancy, chemotherapy, or radiotherapy [2]. The patient usually manifests systemic complications; complications are grouped into early or late [5, 6] Stem cell transplantation includes allogeneic stem cell transplantation in which the patient (recipient) receives stem cells from a donor, and autologous stem cell transplantation, in which stem cells are harvested from the patient himself and reinfused again after completion of his treatment [3, 4].
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