מתוך medicontext.co.il
LONDON (Reuters Health) – Patients with recent respiratory disease and those with persistent proinflammatory alveolar macrophage activity are at high risk of developing lung disease after haematopoietic stem cell transplantation, UK researchers report in the November issue of Thorax.
Dr. Adam T. Whittle from the Bristol Royal Infirmary and colleagues isolated and assayed alveolar macrophages from 32 patients before bone marrow or peripheral blood stem cell transplantation. They repeated the evaluation on 23 of these patients at the nadir of posttransplant pancytopenia.
Within 6 months of stem cell implantation, 11 patients developed lung disease. Before transplantation, based on alveolar macrophage count, these subjects all had significantly higher median concentrations of tumour necrosis factor-alpha (TNF-alpha), granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin-6 compared with subjects who did not develop lung disease, the research team found.
During posttransplant pancytopenia, high levels of GM-CSF were predictive of lung disease. A history of recent chest disease was associated with high production of TNF-alpha and GM-CSF and also predicted lung disease after stem cell transplantation.
"This work should be viewed as preliminary; we cannot yet recommend that all candidates for stem cell transplantation should undergo assay of alveolar macrophage cytokine production," the investigators say. "But this approach has the potential to reduce the exposure of patients to the pulmonary side effects of stem cell transplantation
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