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Diffuse alveolar hemorrhage: retrospective review of clinical outcome in allogeneic transplant recipients treated with aminocaproic acid.

Publication ,  Journal Article
Wanko, SO; Broadwater, G; Folz, RJ; Chao, NJ
Published in: Biol Blood Marrow Transplant
September 2006

Diffuse alveolar hemorrhage (DAH) after allogeneic hematopoietic stem cell transplantation (HSCT) is often fatal. Standard therapy with high-dose corticosteroid is not always effective. There is paucity of data in the literature about other potentially useful agents, such as aminocaproic acid (Amicar) in the post-transplantation setting. We retrospectively reviewed our data on 115 consecutive patients who underwent HSCT and had pulmonary complications, with the aim of determining the overall clinical outcome in recipients of allogeneic transplants and in the subgroup of these patients who were treated with concomitant Solu-Medrol and aminocaproic acid. Aminocaproic acid was added at the discretion of the attending physician. We identified 14 allogeneic transplant recipients (median age, 41 years) with 15 episodes of DAH who were treated with Solu-Medrol (250 mg to 1 g intravenously per day). Of these, 8 patients also received concomitant aminocaproic acid at 1000 mg intravenously every 6 hours. Failure to improve was the most common reason for adding aminocaproic acid. The incidence of DAH was 12.2% (10.3% in myeloablative versus 1.9% in nonmyeloablative recipients). The overall 100-day DAH mortality and median transplantation survival were 60% and 99 days, respectively. Among the subset of patients treated with the combination of Solu-Medrol and aminocaproic acid, we observed a 100-day DAH mortality and median transplantation survival of 44% and 167 days, respectively, compared with 83% and 96.5 days in those treated with Solu-Medrol alone. The median time to DAH was 40.5 days, and the median time to death was 53 days in the combined treatment group compared with 29.5 days in those treated with steroid alone. There were no significant differences in coagulation parameters between subsets. Infections (yeast, respiratory syncytial virus, herpes simplex virus, and parainfluenza) were isolated and treated from 6 diagnostic bronchial alveolar lavage samples and were more common in the subgroup treated with Solu-Medrol only. Respiratory failure was the documented cause of death in 89% of patients. There were no clinically significant side effects from aminocaproic acid. Although these historically lower DAH outcomes are intriguing, prospective studies are needed to confirm the role of aminocaproic acid in DAH occurring in the allogeneic transplantation setting.

Duke Scholars

Published In

Biol Blood Marrow Transplant

DOI

ISSN

1083-8791

Publication Date

September 2006

Volume

12

Issue

9

Start / End Page

949 / 953

Location

United States

Related Subject Headings

  • Time Factors
  • Retrospective Studies
  • Respiratory Insufficiency
  • Neoplasms
  • Middle Aged
  • Methylprednisolone Hemisuccinate
  • Male
  • Lung Diseases
  • Immunology
  • Humans
 

Citation

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ICMJE
MLA
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Wanko, S. O., Broadwater, G., Folz, R. J., & Chao, N. J. (2006). Diffuse alveolar hemorrhage: retrospective review of clinical outcome in allogeneic transplant recipients treated with aminocaproic acid. Biol Blood Marrow Transplant, 12(9), 949–953. https://doi.org/10.1016/j.bbmt.2006.05.012
Wanko, Sam O., Gloria Broadwater, Rodney J. Folz, and Nelson J. Chao. “Diffuse alveolar hemorrhage: retrospective review of clinical outcome in allogeneic transplant recipients treated with aminocaproic acid.Biol Blood Marrow Transplant 12, no. 9 (September 2006): 949–53. https://doi.org/10.1016/j.bbmt.2006.05.012.
Wanko SO, Broadwater G, Folz RJ, Chao NJ. Diffuse alveolar hemorrhage: retrospective review of clinical outcome in allogeneic transplant recipients treated with aminocaproic acid. Biol Blood Marrow Transplant. 2006 Sep;12(9):949–53.
Wanko, Sam O., et al. “Diffuse alveolar hemorrhage: retrospective review of clinical outcome in allogeneic transplant recipients treated with aminocaproic acid.Biol Blood Marrow Transplant, vol. 12, no. 9, Sept. 2006, pp. 949–53. Pubmed, doi:10.1016/j.bbmt.2006.05.012.
Wanko SO, Broadwater G, Folz RJ, Chao NJ. Diffuse alveolar hemorrhage: retrospective review of clinical outcome in allogeneic transplant recipients treated with aminocaproic acid. Biol Blood Marrow Transplant. 2006 Sep;12(9):949–953.
Journal cover image

Published In

Biol Blood Marrow Transplant

DOI

ISSN

1083-8791

Publication Date

September 2006

Volume

12

Issue

9

Start / End Page

949 / 953

Location

United States

Related Subject Headings

  • Time Factors
  • Retrospective Studies
  • Respiratory Insufficiency
  • Neoplasms
  • Middle Aged
  • Methylprednisolone Hemisuccinate
  • Male
  • Lung Diseases
  • Immunology
  • Humans