DIFFUSE ALVEOLAR HEMORRHAGE ASSOCIATED WITH MICROANGIOPATHY AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Microangiopathic disease and diffuse alveolar haemorrhage (DAH) are un common serious complications of bone marrow transplantation (BMT), but an association between these two conditions has not been previously r ecognised, We report 4 patients in whom these two complications occurr ed after allogeneic BMT for haematological malignancy. The patients we re 16-39 years of age, and received transplants for acute myeloid leuk emia, chronic myeloid leukemia and non-Hodgkin's lymphoma (n = 2), Don ors were HLA-identical siblings (n = 3), and a matched unrelated volun teer, The patient with AML was receiving a second transplant for relap se 3 years after her first BMT, and was prepared,vith busulphan and me lphalan; other patients received total body irradiation and cyclophosp hamide, Microangiopathy occurred 20-48 days after BMT, and was associa ted with renal impairment in all cases, and mental confusion in 3, Cyc losporin levels were in the toxic range in 2 cases, DAH occurred 18-55 days after BMT, in 3 cases 2-7 days after the onset of microangiopath y, but preceding it by 14 days in the other case, Patients were treate d with fresh frozen plasma, plasma exchange, supplemental oxygen and v entilation in 2 cases, Two patients died of progressive respiratory fa ilure, while 2 patients recovered with evidence of continuing microang iopathic disease, and died of myocardial infarction or fungal infectio n, We report an association between microangiopathic disease and DAH i n these BMT patients, and suggest that damage to the pulmonary vascula r endothelium may be the common pathophysiological event, although no specific causative factor could be identified.