Pulmonary Complications in Children Following Hematopoietic Cell Transplantation: A Case Report and Review of the Diagnostic Approach.

Lama Elbahlawan,Amr Qudeimat,Robert E Ruiz,Cara E Morin,M Beth Mccarville,Saumini Srinivasan,Hafeez Abdelhafeez,Jenny Mcarthur

doi:10.3389/fonc.2021.772411

Abstract

Pulmonary complications are common in children following hematopoietic cell transplantation (HCT) and contribute to their morbidity and mortality. Early diagnosis is essential for management and prevention of progression of lung injury and damage. In many cases, diagnosis can be challenging and may require diagnostic imaging and more invasive testing such as bronchoscopy and lung biopsy. We report the case of a 12-year-old girl who developed recurrent episodes of acute respiratory failure requiring intensive care unit admission in the post-HCT phase and describe the diagnostic and multidisciplinary approach for her management. In addition, we review the diagnostic approach of pulmonary complications post-HCT and highlight the utility and risks of bronchoscopy and lung biopsy in these children.

Highlights

Pulmonary complications are common in children following hematopoietic cell transplantation (HCT) and contribute to morbidity and mortality in the post-HCT phase [1,2,3]
Non-infectious etiology was diagnosed in lung biopsy more often than bronchoalveolar lavage (BAL); the rate of complication was higher in the lung biopsy group compared to the BAL group (0.15 vs 0.008) [51]
Initial diagnostic imaging may suggest the etiology of the pulmonary process

Summary

INTRODUCTION

Pulmonary complications are common in children following hematopoietic cell transplantation (HCT) and contribute to morbidity and mortality in the post-HCT phase [1,2,3]. Our patient’s second HCT was complicated by CMV reactivation requiring ganciclovir therapy as well as rising LDH, complement level (CH50), proteinuria, and acute kidney injury suspicious for transplant-associated thrombotic microangiopathy (TMA). Pulmonary complications post-HCT are challenging for the radiologist due to pre-existing co-morbidities and co-existence of infectious and non-infectious etiologies, many of which have overlapping imaging findings. Non-infectious late pulmonary complications (>100 days post HCT) include BOS, COP, or non-classifiable interstitial pneumonia [26]. IPS, idiopathic pneumonia syndrome; PERDS, peri-engraftment respiratory distress syndrome; DAH, diffuse alveolar hemorrhage; BOS, bronchiolitis obliterans; COP, cryptogenic organizing pneumonia; VOD, veno-occlusive disease; TA-TMA, transplant associated thrombotic microangiopathy; TNF, tumor necrosis factor; TXA, tranexamic acid; BAL, bronchoalveolar lavage; TLC, total lung capacity; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; DLCO, diffusion lung capacity for carbon monoxide; d, day; m, months; ↑, increased. Ben-Ari et al (2001) [29] Eikenberry et al (2005) [4] Armenian et al (2007) [30] Kasow et al (2007) [31] Efrati et al (2007) [32] Forslow et al (2010) [33] Qualter et al (2014) [34] Nadimpalli et al (2017) [35] Tang et al (2018) [36] Eroglu-Ertugru et al (2020) [37]

90 Pediatrics 32 Pediatrics 89 Pediatrics

Findings

CONCLUSION