High-dose corticosteroid therapy for diffuse alveolar hemorrhage in allogeneic bone marrow stem cell transplant recipients

In a series of 74 patients with hematological malignancies undergoing allog eneic bone marrow or peripheral blood stem cell transplants from an HLA-ide ntical sibling donor, four developed diffuse alveolar hemorrhage (DAH) betw een days 0 and 23 post transplant. Diagnosis was made by the radiographic f inding of diffuse bilateral lung opacities, and bloody lavage fluid on bron choscopy, Two patients required mechanical ventilatory support. They were t reated with methyl-prednisolone 0.25-1.5 g/day for at least 4 days with slo w tapering thereafter. All patients showed an immediate response and two be came long-term survivors with normal respiratory function, Two had a relaps e of DAH, developed acute respiratory distress syndrome (ARDS) and died wit h multi-organ failure. Risk factors for DAH were one or more courses of int ensive chemotherapy pretransplant vs no treatment or low-dose chemotherapy (4/4 DAH vs 23/70 no DAH; P = 0.015), and second transplants (2/2 DAH vs 1/ 70 with no DAH; P = 0.006), These results indicate that DAH is life-threate ning but is potentially reversible by prompt treatment with high doses of s teroids.