Pulmonary cytolytic thrombi : a newly recognized complication of stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 25; no. 3; pp. 293 - 300
• Main Authors: WOODARD, J. P, GULBAHCE, E, SHREVE, M, STEINER, M, PETERS, C, HITE, S, RAMSAY, N. K. C, DEFOR, T, BAKER, K. S
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.02.2000
• Subjects: Adolescent; Adult; Amorphous materials; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Biological and medical sciences; Biopsy; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Bronchoalveolar Lavage; Bronchoalveolar Lavage Fluid - microbiology; Child; Child, Preschool; Combined Modality Therapy; Corticoids; Corticosteroids; Endothelium; Female; Fever; Graft vs Host Disease - etiology; Graft-versus-host reaction; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Infant; Infection - etiology; Leukocytes; Lung nodules; Male; Medical sciences; Nodules; Patients; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - etiology; Pulmonary Embolism - pathology; Radiography, Thoracic; Solitary Pulmonary Nodule - diagnostic imaging; Solitary Pulmonary Nodule - etiology; Solitary Pulmonary Nodule - pathology; Stem cell transplantation; Stem cells; Time Factors; Tomography, X-Ray Computed; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning; Human; Lung disease; Respiratory disease; Stem cell; Lung; Hematopoietic cell; Homograft; Cardiovascular disease; Thrombosis; Vascular disease; Complication; Graft; Thromboembolism
• DOI: 10.1038/sj.bmt.1702137
• ISSN: 0268-3369

Over the past 5 years we have recognized a new pulmonary complication of hematopoietic stem cell transplantation (HSCT) associated with fever and pulmonary nodules termed 'pulmonary cytolytic thrombi' (PCT). Retrospective analysis of medical and radiographic records and pathologic material from 13 HSCT recipients with PCT and a review of the Blood and Marrow Transplant Database for all patients with radiographic evidence of pulmonary nodules or who underwent open-lung biopsy from 1 January 1993 to 31 December 1998 (n = 1228) were performed. The median age of patients with PCT was 11.9 years (range, 1.3-29.7 years). All patients developed fever at a median of 72 days (range, 8-343 days) post transplant, followed by pulmonary nodules on chest CT. Eleven patients were receiving therapy for active GVHD (acute, grades I-IV (n = 10); extensive chronic (n = 1)). Biopsy of the pulmonary nodules revealed a unique pattern of necrotic, basophilic thromboemboli with amorphous material suggestive of cellular breakdown products. This was descriptively labeled 'pulmonary cytolytic thrombi'. Immunohistochemical staining revealed entrapped leukocytes and disrupted endothelium, but was negative for histiocytes. Cultures and immunohistochemical stains were negative for infectious agents. Empiric therapy included systemic corticosteroids (n = 9) and amphotericin (n = 7). Nine patients survive with resolution of PCT at a median follow-up of 1.5 years. Bone Marrow Transplantation (2000) 25, 293-300.