Airway inflammation predicts diffuse alveolar hemorrhage during bone marrow transplantation in patients with Hodgkin disease

Joseph Harold Sisson, Austin Bassett Thompson, J. R. Anderson, R. A. Robbins, J. R. Spurzem, P. R. Spence, Elizabeth Cecile Reed, James Olen Armitage, Julie Marie Vose, M. A. Arneson, W. P. Vaughan, S. I. Rennard

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

We determined risk factors present in patients with Hodgkin disease that predicted the development of diffuse alveolar hemorrhage syndrome (DAH) during autologous bone marrow transplantation (BMT). One hundred twenty-three patients with Hodgkin disease prospectively underwent bronchoscopy with bronchoalveolar lavage (BAL) before receiving BMT. The bronchitis index (BI) of the airways and bronchial and alveolar cell counts and differentials were determined in all patients and compared with 20 normal nonsmoking volunteers. Logistic regression analysis was used to determine factors that predicted for the development of DAH. Visual evidence of bronchial injury was observed regardless of smoking history (BI = 7.8 ± 0.5 for BMT versus 2.3 ± 0.5 for volunteers, p = 0.001). BMT patients who developed DAH (n = 14) had significantly greater numbers of bronchial neutrophils and eosinophils compared with DAH-negative (n = 109) patients (bronchial polymorphonuclear leukocytes (PMN), 33 ± 7% versus 14 ± 2%, p = 0.006; bronchial eosinophils, 0.9 ± 0.3% versus 0.4% ± 0.07%, p = 0.02). Logistic regression analysis revealed that the presence of bronchial PMN > 20% or bronchial eosinophils > zero% were predictive of DAH (p = 0.005 and 0.05, respectively). When both predictors were positive, the rate of DAH was 10 times greater than when both predictors were negative (43% versus 4% DAH occurrence). Survival was also significantly reduced when these predictors were positive. This study demonstrates that bronchial inflammation is present with or without intraluminal inflammatory cells in the majority of patients with Hodgkin disease before BMT. The subgroup of these patients with increased bronchial inflammatory cells are at greatly increased risk for development of DAH and death.

Original languageEnglish (US)
Pages (from-to)439-443
Number of pages5
JournalAmerican Review of Respiratory Disease
Volume146
Issue number2
DOIs
StatePublished - Jan 1 1992

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Bone Marrow Transplantation
Hodgkin Disease
Hemorrhage
Inflammation
Eosinophils
Neutrophils
Bronchitis
Logistic Models
Regression Analysis
Alveolar Epithelial Cells
Autologous Transplantation
Bronchoscopy
Bronchoalveolar Lavage
Volunteers
Healthy Volunteers
Cell Count
Smoking
History
Survival
Wounds and Injuries

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Airway inflammation predicts diffuse alveolar hemorrhage during bone marrow transplantation in patients with Hodgkin disease. / Sisson, Joseph Harold; Thompson, Austin Bassett; Anderson, J. R.; Robbins, R. A.; Spurzem, J. R.; Spence, P. R.; Reed, Elizabeth Cecile; Armitage, James Olen; Vose, Julie Marie; Arneson, M. A.; Vaughan, W. P.; Rennard, S. I.

In: American Review of Respiratory Disease, Vol. 146, No. 2, 01.01.1992, p. 439-443.

Research output: Contribution to journalArticle

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abstract = "We determined risk factors present in patients with Hodgkin disease that predicted the development of diffuse alveolar hemorrhage syndrome (DAH) during autologous bone marrow transplantation (BMT). One hundred twenty-three patients with Hodgkin disease prospectively underwent bronchoscopy with bronchoalveolar lavage (BAL) before receiving BMT. The bronchitis index (BI) of the airways and bronchial and alveolar cell counts and differentials were determined in all patients and compared with 20 normal nonsmoking volunteers. Logistic regression analysis was used to determine factors that predicted for the development of DAH. Visual evidence of bronchial injury was observed regardless of smoking history (BI = 7.8 ± 0.5 for BMT versus 2.3 ± 0.5 for volunteers, p = 0.001). BMT patients who developed DAH (n = 14) had significantly greater numbers of bronchial neutrophils and eosinophils compared with DAH-negative (n = 109) patients (bronchial polymorphonuclear leukocytes (PMN), 33 ± 7{\%} versus 14 ± 2{\%}, p = 0.006; bronchial eosinophils, 0.9 ± 0.3{\%} versus 0.4{\%} ± 0.07{\%}, p = 0.02). Logistic regression analysis revealed that the presence of bronchial PMN > 20{\%} or bronchial eosinophils > zero{\%} were predictive of DAH (p = 0.005 and 0.05, respectively). When both predictors were positive, the rate of DAH was 10 times greater than when both predictors were negative (43{\%} versus 4{\%} DAH occurrence). Survival was also significantly reduced when these predictors were positive. This study demonstrates that bronchial inflammation is present with or without intraluminal inflammatory cells in the majority of patients with Hodgkin disease before BMT. The subgroup of these patients with increased bronchial inflammatory cells are at greatly increased risk for development of DAH and death.",
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