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Pneumologie 2000; 54(5): 191-200
DOI: 10.1055/s-2000-9085
ÜBERSICHT
Georg Thieme Verlag Stuttgart ·New York

Pulmonale Komplikationen nach hämatopoetischer Stammzelltransplantation im Kindesalter

K. Paul1 , I. Kleinau1 , W. Ebell2
  • Charité, Campus Virchow-Klinikum, Otto-Heubner-Centrum,
  • 1Klinik für Pädiatrie m. S. Pneumologie/Immunologie (Prof. Dr. U. Wahn)
  • 2Klinik für Allgemeine Pädiatrie, (Prof. Dr. G. Gaedicke), Augustenburger Platz 1, Berlin
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Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung

Die Gesamtmortalität der verschiedenen Formen der hämatopoetischen Stammzelltransplantation (HST) konnte während der letzten Jahre für das Kindesalter deutlich reduziert werden. Die Therapiemortalität beträgt in Abhängigkeit von der Art der Transplantation bei HLA-identischen, intrafamiliären Transplantationen unter 10 %, bei HLA-differenten, intrafamiliären sowie HLA-unverwandten Transplantationen ca. 20 - 40 %. Demgegenüber nehmen pulmonale Komplikationen in der Todesursachenstatistik nach HST nach wie vor einen bedeutenden Platz ein. In der neutropenischen Phase nach Transplantation treten sie in Form des Engraftment-Syndroms, in der weiteren Frühphase darüber hinaus in Form einer infektiös bedingten Pneumonitis, eines Idiopathischen Pneumonie-Syndroms (IPS) oder eines Diffusen Alveolären Hämorrhagie Syndroms (DAH) auf. Die Lunge wird darüber hinaus als Teil eines systemischen infektiösen oder vaskulären Prozesses (Kapillar-Leck-Syndrom, thrombotisch-thrombozytopenische Purpura, Zytokin-Syndrom, septischer Schock) mit daraus häufig resultierendem Multiorganversagen involviert. Pulmonale Spätschäden manifestieren sich v. a. als Bronchiolitis obliterans (BO), Bronchiolitis obliterans organizing pneumonia (BOOP) oder Lungenfibrose. Das Ausmaß der pulmonalen Mortalität und Morbidität, der Schweregrad und das Spektrum pulmonaler Erkrankungen bei Kindern sowie die Relevanz möglicher monokausaler bzw. multifaktorieller ätiologischer Risikofaktoren (GVH-Krankheit, Radiatio, Chemotherapie, Virus- und Pilzinfektionen) sind nach wie vor ungenügend klassifiziert [[1], [2]]. Als Grundlage für ein interdisziplinäres Herangehen sollen folgende Themen in Form einer Übersicht angesprochen werden:

Hämatopoetische Stammzelltransplantation bei Kindern - Häufigkeit und Ergebnisse Pulmonale Mortalität/Morbilität und therapeutische Möglichkeiten Frühe Komplikationen Späte Komplikationen Risikofaktoren Chronische Graft-versus Host-Reaktionen Konsequenzen

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Prof. Dr. K. Paul

Charité, Campus Virchow-Klinikum Klinik für Pädiatrie m.S. Pneumologie/Immunologie

Augustenburger Platz 1

13353 Berlin