Respiratory failure in the hematopoietic stem cell transplant recipient

Abstract

The number of patients receiving hematopoietic stem cell transplantation (HSCT) is rapidly rising worldwide. Despite substantial improvements in peri-transplant care, pulmonary complications resulting in respiratory failure remain a major contributor to morbidity and mortality in the post-transplant period, and represent a major barrier to the overall success of HSCT. Infectious complications include pneumonia due to bacteria, viruses, and fungi, and most commonly occur during neutropenia in the early post-transplant period. Non-infectious complications include idiopathic pneumonia syndrome, peri-engraftment respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary veno-occlusive disease, delayed pulmonary toxicity syndrome, cryptogenic organizing pneumonia, bronchiolitis obliterans syndrome, and post-transplant lymphoproliferative disorder. These complications have distinct clinical features and risk factors, occur at differing times following transplant, and contribute to morbidity and mortality.

Keywords: Respiratory failure; Pulmonary complications; Hematopoietic stem cell transplantation; Stem cell transplant; Immunocompromised host

Core tip: Respiratory failure in the hematopoietic stem cell transplant recipient is common and is a major contributor of morbidity, mortality, and healthcare utilization. Etiology may be infectious or non-infectious in nature, and in some cases these may coexist. While identification remains challenging, infectious and non-infectious syndromes have distinct clinical features and risks.