Peri-engraftment respiratory distress syndrome during autologous hematopoietic stem cell transplantation

From 1987 to 1998, 19 of 416 patients (4.6%) underwent autologous hematopoi etic stem cell transplantation experienced peri-engraftment (within 5 days of neutrophil recovery) respiratory distress syndrome (PERDS) not attributa ble to infection, fluid overload, or cardiac dysfunction, The median time f rom stem cell infusion to onset of PERDS was 11 days (range 4-25), Risk of PERDS or its outcome was not predicted by any pre- or peri-transplant clini cal or laboratory feature. The respective median white blood cell and plate let counts at first symptoms were 1.3 x 10(9)/l and 25 x 10(9)/l, No patien ts had an infectious etiology by bronchoalveolar lavage, Six of the 19 pati ents had alveolar hemorrhage, which was significantly correlated with high neutrophil count. PERDS was directly implicated in four deaths (21%). Eleve n patients received high-dose corticosteroid therapy, including five of the six who required mechanical ventilation. Ten of these patients experienced clinical improvement, which occurred within 24 h in five. The rapid respon se to corticosteroid treatment and the fact that such therapy was delayed u ntil after intubation in all the mechanically ventilated cases point to a t herapeutic benefit.