[Pulmonary complications after bone marrow transplantation]

Pulmonary complications represent a major cause of morbidity and mortality in patients undergoing allogenic and autologous bone marrow transplantation (BMT). These include a broad spectrum of diseases affecting the lungs and airways, some with predominantly early time of onset (within weeks) and others late (beyond three months) after BMT. The major contributing factors to the occurrence of infectious and noninfectious pulmonary complications of BMT are the state of immunosuppression, secondary to the total body irradiation and chemotherapy used prior to BMT, and acute or chronic graft-versus-host disease. Early and accurate diagnosis by chest roentgenogram, bronchoscopy, and bronchoalveolar lavage combined with appropriate laboratory techniques is essential, as prompt specific treatment clearly has beneficial effects. An increasing number of pulmonary complications appears to be preventable by improving the conditioning regimes, accelerating engraftment and immune reconstitution, prophylactic antibacterial, antimycotic, and antiviral therapy as well as the modification of GVHD therapy.