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Thoracic complications related to bone marrow transplantation
A A Floreani1, J H Sisson, J Gurney
1Section of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Nebraska Health Systems, Omaha, USA.
Abstract:
Although progress has been made in the diagnosis and management of respiratory complications after BMT, such complications are still frequent and are a major cause of morbidity and mortality. The use of CMV-negative marrow and blood products, surveillance bronchoscopies, and prophylactic use of antivirals have significantly reduced the incidence of CMV pneumonia. DNA amplification techniques have allowed earlier detection of viral respiratory infections, and early detection of localized invasive aspergillosis can improve survival with lung resection and antifungal therapy. Finally, consideration for open lung biopsy should include the patient's degree of preoperative respiratory impairment, because this may relate to early postoperative survival.
Insights
Respiratory complications post-bone marrow transplant (BMT) remain a significant concern. Advances in diagnostics and treatments, including CMV-negative products and early detection of infections, are improving patient outcomes and survival rates.
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- Respiratory complications are a major cause of morbidity and mortality after bone marrow transplantation (BMT).
- Despite progress, these complications remain frequent challenges in BMT patient care.
Purpose of the Study:
- To review current strategies for diagnosing and managing respiratory complications following BMT.
- To highlight advancements in reducing the incidence and improving the outcomes of these complications.
Main Methods:
- Review of established and emerging diagnostic techniques for respiratory infections post-BMT.
- Discussion of prophylactic and therapeutic interventions for common respiratory complications.
- Analysis of factors influencing survival, including diagnostic timing and treatment approaches.
Main Results:
- Use of cytomegalovirus (CMV)-negative marrow and blood products, surveillance bronchoscopies, and antiviral prophylaxis have decreased CMV pneumonia incidence.
- DNA amplification techniques enable earlier detection of viral respiratory infections.
- Early diagnosis of invasive aspergillosis improves survival through lung resection and antifungal therapy.
Conclusions:
- Early detection and targeted therapies are crucial for managing respiratory complications after BMT.
- Consideration of patient respiratory status is vital when planning invasive procedures like open lung biopsy.