Diffuse alveolar hemorrhage due to donor lymphocyte infusion in a case of acute lymphoblastic leukemia

Diffuse alveolar hemorrhage, with a mortality rate between 60-100%, is a life-threatening complication in hematopoietic stem cell transplant recipients. A 34-year-old man, with precursor B acute lymphoblastic leukemia diagnosed in July 2003, relapsed after allogeneic peripheral blood hematopoietic stem cell transplantation from his human leukocyte antigen- iden¬tical brother in July 2005. He received a donor lymphocyte infusion of 2 x 107/kg CD3 positive cells. He developed fever, dyspnea and hypoxemia four days after donor lymphocyte infusion. The patient was diagnosed as diffuse alveolar hem¬orrhage based on the clinical, radiological and bronchoscopic data. He was immediately started on high-dose methylpred¬nisolone. Two days after the onset of the steroid therapy, he recovered with significant improvement in oxygenation. Diffuse alveolar hemorrhage can be a late-onset transplant complication that could also be associated with a recent donor lymphocyte infusion.