IDIOPATHIC PNEUMONIA SYNDROME AND RESPIRATORY-FAILURE AFTER MARROW TRANSPLANTATION

Historically, pulmonary disease occurs in 40 to 60% of patients after marrow transplantation. Now the sources of donor stem cells to serve a s a marrow graft have expanded from autologous and sibling (allogeneic ) bone marrow to include a pool of unrelated marrow donors, fetal cord blood, and growth factor-stimulated peripheral blood. It is unclear w hether the use of these alternative hematopoietic precursors will alte r the incidence of pulmonary complications. It is likely that lung inj ury, especially that associated with intensive chemo-irradiation thera py, will continue. Recently, the spectrum of idiopathic lung injury ha s been recognized as a syndrome (idiopathic pneumonia syndrome, IPS). The diagnosis of IPS is defined by a bronchoalveolar lavage that does not reveal an infection, in the presence of nonlobar radiographic infi ltrates, and physiological changes consistent with pneumonia. Data sug gest that the majority of these cases progress to respiratory failure and multiorgan failure that carries a significant mortality. With pres ent life-support and treatment, the combination of severe lung injury with either significant hepatorenal insufficiency or hypotension appea rs uniformly fatal.