PURPOSE: Hematopoietic stem cell transplantation (HSCT) is associated with a high rate of pulmonary complications, but little has been described about pleural effusions. Graft versus host disease (GVHD) may also manifest as pleural effusion.
METHODS: Patients with HSCT who underwent thoracentesis from January 1997 to December 2007 were identified. Clinical history and laboratory data were reviewed retrospectively.
RESULTS: Forty patients underwent 66 procedures: 65% allogeneic, 30% autologous, and 5% cord-blood. No complications were associated with the procedure. The allogeneic group included lymphoma (12) and leukemia (14). Most patients had unilateral effusions(23), but 3 patients had bilateral effusions. Fifteen (15) patients had a single thoracentesis, while 11 patients required multiple procedures. One patient underwent pleural biopsy which revealed chronic inflammation. The time from HSCT to thoracentesis ranged from 1 to 3255 days. Overall, pleural effusion was due to infection (42.8%), malignancy (10.7%), volume overload (7%), engraftment syndrome(7%), and unknown (21%). Within the first 50 days after transplant, 11 patients underwent thoracentesis, and the primary etiologies of pleural effusion included volume overload (45%), infection (27%), and unknown (27%). Within this group, two patients developed GVHD, and had effusions of unclear etiology. Between day 50 to 100, thoracentesis was done on 4 patients, and the primary etiology of pleural effusion was infection (75%) and volume overload (25%). One patient had GVHD with infection as the cause of the pleural effusion. From day 100 onward, 12 patients underwent thoracentesis. The primary causes included infection (42%), volume overload (16%), malignancy (16%), GVHD (8%), hemothorax (8%) and unknown (8%). Nine patients in this group had concurrent GVHD.
CONCLUSION: Prompt evaluation with thoracentesis may significantly impact clinical management, for the cause of these effusions, including infection, volume overload, and recurrence of disease, may be easily identified.
CLINICAL IMPLICATIONS: Pleural effusions are perceived to be rare in HSCT. Further evaluation with pleural biopsy for effusions of unclear etiology may provide definitive diagnosis. The role of GVHD in these pleural effusions remains elusive and warrants further evaluation.
DISCLOSURE: Audrey Nguyen, No Financial Disclosure Information; No Product/Research Disclosure Information