DIFFUSE ALVEOLAR HEMORRHAGE FOLLOWING AUTOLOGOUS BONE-MARROW INFUSION

Autologous BMT performed in a 57-year-old woman with relapsed large ce ll lymphoma was complicated bv two consecutive episodes of diffuse alv eolar hemorrhage (DAH). The second episode occurred immediately after infusion of autologous BM. DAH is an increasingly recognized complicat ion of autologous BMT and carries a high mortality. It is characterize d by dyspnea, cough, bilateral pulmonary infiltrates and progressively bloodier aliquots of bronchoalveolar lavage fluid. The pathogenesis i s probably multifactorial involving an initial insult to lung endothel ium with inflammatory cells serving as the mediators of subsequent inj ury. The rapid development of DAH following marrow infusion strongly i mplicates DMSO as a potential cause in our patient.