A Call to Arms: a Critical Need for Interventions to Limit Pulmonary Toxicity in the Stem Cell Transplantation Patient Population

摘要: Noninfectious pulmonary toxicity after allogeneic hematopoietic stem cell transplantation (allo-HSCT) causes significant morbidity and mortality. Main presentations are idiopathic pneumonia syndrome (IPS) in the acute setting bronchiolitis obliterans (BOS) cryptogenic organizing (COP) at later time point. While COP responds well to corticosteroids, IPS BOS often treatment refractory. IPS, most cases, is rapidly fatal, whereas progresses over time, resulting chronic respiratory failure, impaired quality of life, eventually, death. Standard second-line treatments currently lacking, current approaches, such as augmented T cell-directed immunosuppression, B depletion, TNF blockade, extracorporeal photopheresis, tyroskine kinase inhibitor therapy, unsatisfactory with responses only a subset patients. Better understanding underlying pathophysiology hopefully results identification future targets for preventive therapeutic strategies along an emphasis on underutilized rehabilitative supportive measures.