Pulmonary hemorrhage as a cause of death in allogeneic bone marrow recipients with severe acute graft-versus-host disease

Kirk J. Wojno, Georgia Boyce Vogelsang, William E. Bescnorner, George W. Santos

Research output: Contribution to journalArticle

Abstract

Acute graft-versus-host disease (GVHD) has recently been associated with endothelial cell injury. The potential clinical significance was explored here in an autopsy review. Thirty-seven allogeneic bone marrow recipients were identified in the autopsy files at The Johns Hopkins Hospital with no evidence of systemic infection. Forty-one percent (15/37) of these patients were found to have extensive recent pulmonary hemorrhage at autopsy which was thought to have led to terminal respiratory failure and death. The 37 patients were divided into 2 groups: those with significant acute GVHD (stage 2 or greater) and those without GVHD (stage 0 or 1). Fifty-nine percent (10/17) of the patients with significant acute GVHD died of acute respiratory failure due to recent pulmonary hemorrhage as opposed to 25% (5/20) of those without acute GVHD (Pa0.032, Fisher’s exact test). Terminal pulmonary hemorrhage was also associated with preparation for BMT, with 67% (12/18) of those prepared with total body irradiation (TBI) having pulmonary hemorrhage as opposed to 15% (3/19) of those prepared with chemotherapy using Busulphan (P=0.002). There was no significant difference in posttransplant survival, engraftment, or final platelet count between the patients stratified by GVHD or preparative protocol. The data support a strong association between significant acute GVHD and terminal hemorrhage, as well a possible association between TBI and pulmonary hemorrhage. Analysis of variance demonstrates that GVHD and TBI are independently associated with increased pulmonary hemorrhage (P

Original languageEnglish (US)
Pages (from-to)88-92
Number of pages5
JournalTransplantation
Volume57
Issue number1
StatePublished - 1994

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Graft vs Host Disease
Cause of Death
Bone Marrow
Hemorrhage
Lung
Whole-Body Irradiation
Autopsy
Respiratory Insufficiency
Busulfan
Platelet Count
Analysis of Variance
Endothelial Cells
Drug Therapy
Survival
Wounds and Injuries
Infection

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Pulmonary hemorrhage as a cause of death in allogeneic bone marrow recipients with severe acute graft-versus-host disease. / Wojno, Kirk J.; Vogelsang, Georgia Boyce; Bescnorner, William E.; Santos, George W.

In: Transplantation, Vol. 57, No. 1, 1994, p. 88-92.

Research output: Contribution to journalArticle

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