Table 2.
Salient Clinical Features of Lung Injury Syndromes Defined under IPS
| Parenchyma |
| Acute interstitial pneumonitis: onset day 0-100 after transplantation. Secondary to chemotoxicity (BCNU, bleomycin, busulfan). |
| ARDS: Noncardiogenic capillary leak syndrome with onset day 0-30 after transplantation. |
| Delayed pulmonary toxicity syndrome: presents months to years after auto HSCT for breast cancer. |
| Vascular endothelium |
| Peri-engraftment respiratory distress syndrome: present within 5-7 days of engraftment may progress to ARDS. |
| Diffuse alveolar hemorrhage: progressively bloodier BAL fractions, presents within 0-100 days after transplantation. |
| Airway epithelium [6] |
| BOS: Diminished FEV1, onset 3-24 months after transplantation. Chest radiography may be normal or show hyperinflation. Chest CT may show mosaic attenuation, air trapping, septal lines, centrilobular nodules or bronchiectasis. Histology reveals bronchiolar inflammation with luminal obstruction. |
| COP (formerly known as bronchiolitis obliterans organizing pneumonia or BOOP): restrictive findings on spirometry, impaired DLCO, onset 2-12 months after transplantation. Chest CT may show patchy airspace disease, or nodular opacities. Histology reveals intraluminal organizing fibrosis in distal airspaces with mild interstitial inflammation. |
BCNU indicates Carmustine; DLCO, diffusing capacity for carbon monoxide; CT, computed tomography.