Acute Pulmonary Complications of Bone Marrow and Stem Cell Transplantation

Recipients of hematopoietic cell transplantation (HCT) are at risk for a variety of acute pulmonary complications including infectious pneumonias and noninfectious acute lung injury syndromes. With advances in HCT technology, prophylaxis and supportive care, overall survival after HCT has improved and the epidemiology of respiratory complications has shifted from early onset to late onset after HCT. However, acute respiratory failure remains the most common indication for admission to an intensive care unit in this population and prognosis is generally poor. Given the broad differential diagnosis of radiographic pulmonary abnormalities in HCT recipients, prompt evaluation with noninvasive testing and invasive diagnostics such as bronchoscopy is warranted. This chapter reviews the current understanding of etiology, diagnostic considerations and treatment of significant acute pulmonary complications in HCT, including idiopathic pneumonia syndrome, cryptogenic organizing pneumonia, and cytomegalovirus pneumonia.