Interstitial Pneumonia in Leukemia Patients after Allogeneic Bone Marrow Transplantation

Abstract

Interstitial pneumonia (IP) occurred among 14 of 31 leukemia patients received allogeneic bone marrow transplantion (45.2%) and it was fatal at 9 cases. IP was clinically suspected by symptoms, chest roentgengram, blood gas analysis and CT scan, and pathologically diagnosed on the specimens obtained by transbronchial lung biopsy or autopsy. At 11 out of 14 cases, the association of cytomegalovirus (CMV) was identified by the positive viral cultures from bronchoalveolar fluid or CMV inclusion body in autopsy specimens. The other 3 cases were diagnosed as idiopathic IP.
Significant risk factors for IP included the sex of recipient (the incidence of IP was 13 of 21 cases in male and one of 10 cases in female. p<0.025) and the additional preconditioning with cytotoxic agents and/or splenic irradiation other than cyclophosphamide (CY) and total body irradiation (TBI) (5/5, 100% compared with 7/25, 28% in cases received conditioning with CY and TBI. p<0.05). Insignificant predisposing factors were the type of disease (5/7, 71.4% with chronic mylogenous leukemia) and the clinical status of patients at the time of BMT (5/17, 29.4% in remission v.s 9/14, 64.3% in relapse or non-chronic phase).
The use of blood donors seronegative for CMV antibody (CF<8) and high-titered CMV immune globulin were not preventive for IP in our cases. As therapy for IP, high-titered CMV immune globulin, acyclovir and corticosteroid (standard dose or high-dose methylprednisolone) were used. Seven cases responded to the corticosteroid therapy and 5 of them survived.