Small-airways disease in recipients of allogeneic bone marrow transplants. An analysis of 11 cases and a review of the literature

Medicine (Baltimore). 1987 Sep;66(5):327-40. doi: 10.1097/00005792-198709000-00001.


In a retrospective review of 116 consecutive allogeneic bone marrow transplants (BMT), severe obstructive airways disease was identified in 11 patients. Lung pathology demonstrated bronchiolitis in 9 patients and physiologic studies showed small-airways disease consistent with bronchiolitis in the other 2. None of the 5 patients with associated infection survived, while 3 of the 6 patients without an identified pathogen stabilized or improved. Analysis of the 11 cases presented and all 25 cases reported in the literature (1982 to 1985) supports the conclusion that graft-versus-host disease is a major risk factor for bronchiolitis in BMT recipients. Among the proposed mechanisms for the development of bronchiolitis after allogeneic BMT, the 2 most likely are graft-versus-host disease directly causing bronchiolitis, and increased immunosuppressive therapy given for graft-versus-host disease predisposing to viral bronchiolitis. The available evidence would suggest that it is prudent to obtain serial pulmonary function tests even in asymptomatic patients post-BMT, and particularly in those with chronic graft-versus-host disease, in the hope that early detection will allow for early intervention that will arrest or reverse the progression of the obstructive airways disease.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Aplastic / therapy
  • Bone Marrow Transplantation*
  • Bronchiolitis, Viral / etiology*
  • Bronchiolitis, Viral / mortality
  • Bronchiolitis, Viral / pathology
  • Female
  • Graft vs Host Disease / mortality*
  • Graft vs Host Disease / pathology
  • Humans
  • Leukemia / therapy
  • Lung Diseases / etiology
  • Lung Diseases / mortality
  • Lung Diseases / pathology
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prognosis