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Invited Commentary

Department of Radiology, Rainbow Babies and Children’s Hospital of the University Hospitals of Cleveland and Case School of Medicine, Cleveland, Ohio

Great strides have been made in the past decade in the use of hematopoietic stem cell transplantation in the treatment of patients with malignancies. The introduction of nonmyeloablative stem cell transplants with less intense conditioning regimens than conventional myeloablative transplants has allowed this therapy to be used in older recipients and in recipients with significant co-morbidities. In addition, the number of potential applications of the treatment is increasing, since hematopoietic stem cell transplantation is increasingly being used in patients with solid organ malignancies. The growing therapeutic role of hematopoietic stem cell transplantation requires that radiologists become familiar with the basic clinical aspects of the procedure and the various complications that may develop following its use.

The excellent study by Coy et al (1) in this issue reviews the basic clinical aspects of myeloablative and nonmyeloablative hematopoietic stem cell transplantation and the imaging appearance of a variety of pulmonary and abdominal complications associated with autologous, syngeneic, and allogeneic transplants. The differential diagnosis for these complications clearly depends on the type of transplant, the conditioning regimen, and the amount of time elapsed since transplantation. Organizing potential complications according to these criteria allows the consulting radiologist to provide a more concise and tailored differential diagnosis.

The complications in the preengraftment phase (ie, the first 30 days following transplantation) relate primarily to pancytopenia and other chemotherapy-related complications such as mucositis. These preengraftment phase complications include fungal infection, diffuse alveolar hemorrhage, VOD, neutropenic typhlitis, and hemorrhagic cystitis. During the early posttransplantation phase (ie, 31–100 days after the procedure), many complications are related to continued deficiencies in cellular and humoral immunity. These complications include infections such as angioinvasive aspergillosis as well as CMV, idiopathic pneumonia syndrome, and pulmonary edema. Late complications (ie, more than 100 days after transplantation) are more commonly seen following allogeneic transplantation, particularly since these patients are more susceptible to GVHD. Other complications occurring during this period include cryptogenic organizing pneumonia and alveolar proteinosis.

Pulmonary complications are of particular significance because they can cause significant morbidity and mortality (2). The Aspergillus genus is of particular importance because it is the most common fungal pathogen. Aspergillus infection occurs in approximately 10% of allogeneic transplant recipients (1). Imaging findings are quite variable, ranging from parenchymal nodules that may cavitate, to diffuse ground-glass attenuation. Aspergillus infection may arise at any time following transplantation.

In summary, hematopoietic stem cell transplantation is associated with a variety of pulmonary and abdominal complications. Awareness of the time course of specific complications and the risk factors associated with these complications will lead to enhanced diagnostic specificity.

	References

Top References

 

1. Coy DL, Ormazabal A, Godwin JD, Lalani T. Imaging evaluation of pulmonary and abdominal complications of hematopoietic stem cell transplantation. RadioGraphics 2004; 25:305–318.
2. Soubani AO, Miller KB, Hassoun PM. Pulmonary complications of bone marrow transplantation. Chest 1996; 109:1066–1077.[Free Full Text]

This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sivit, C. J. Search for Related Content PubMed Articles by Sivit, C. J. Related Collections Related Article