Diffuse alveolar hemorrhage following allogeneic bone marrow transplantation in children

Background: Diffuse alveolar hemorrhage (DAH) is a frequent life-threatening complication of bone marrow transplantation (BMT) in adults. This noninfectious pulmonary disorder is rarely reported following BMT in neonates and children. Study objectives: To review the clinical features and course of children who underwent allogeneic BMT and developed DAH in the posttransplant period. Design: A retrospective 6-year chart review. Setting: Pediatric ICU in a university hospital. Patients and interventions: At total of 138 children who had undergone allogeneic BMT for nonmalignant (n 66) or malignant (n 72) diseases. Measurements and results: Six of 138 children (4.3%) aged 2 months to 10 years (male/female ratio, 1:1) developed DAH. Each had a fulminant course with rapidly developing severe respiratory failure, mandating mechanical ventilation within 24 h following symptom onset. They were all treated with methylprednisolone, 6 mg/kg/d for 3 days. Only one child survived, and there have been no sequelae at 2 years post-BMT. Four children died of respiratory causes, and one died of multiorgan failure. Conclusions: DAH is a potentially fatal respiratory complication that should be included early in the differential diagnosis of acute respiratory failure in children following allogenic BMT for both malignant and nonmalignant diseases. Therapy with high doses of steroids apparently do not affect the course of the disease. (CHEST 2003; 124:660 – 664)