Abstract
Historically, pulmonary disease occurs in 40 to 60% of patients after marrow transplantation.
Now, the sources of donor stem cells to serve as a marrow graft have expanded from
autologous and sibling (allogeneic) bone marrow to include a pool of unrelated marrow
donors, fetal cord blood, and growth factor-stimulated peripheral blood. It is unclear
whether the use of these alternative hematopoietic precursors will alter the incidence
of pulmonary complications. It is likely that lung injury, especially that associated
with intensive chemo-irradiation therapy, will continue. Recently, the spectrum of
idiopathic lung injury has been recognized as a syndrome (idiopathic pneumonia syndrome,
IPS). The diagnosis of IPS is defined by a bronchoalveolar lavage that does not reveal
an infection, in the presence of nonlobar radiographic infiltrates, and physiological
changes consistent with pneumonia. Data suggest that the majority of these cases progress
to respiratory failure and multiorgan failure that carries a significant mortality.
With present life-support and treatment, the combination of severe lung injury with
either significant hepatorenal insufficiency or hypotension appears uniformly fatal.
