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- • Pneumonia The lung seems to be the organ most sensitive to the adverse effects of transplantation. It has
- been suggested that the lung is to bone marrow transplantation what the quarterback's knee is to the football
- game. A lot can go wrong. The lung can be injured because of infection, because of the toxic effect of high-dose
- chemotherapy and radiation or because of some unknown cause.
- When severe pneumonia develops after a bone marrow transplant, death often— but not always—results.
- The most common pneumonia in these cases is caused by cytomegalovirus, a particularly severe pneumonia
- that can develop several months after the transplant. If it does develop, it is often in association with another
- serious complication, graft-versus-host disease .
- • Graft-versus-host disease After an allogeneic bone marrow transplant, the immunologically active cells in the
- new marrow can recognize the "host" organism—the patient receiving the transplant—as foreign and go on the
- attack. The most commonly damaged organs are the skin, liver and intestines.
- Medicines can be given after the transplant to reduce the possibility of graft-versus-host disease. The
- marrow can also be treated outside the body to remove the cells that cause graft-versus-host disease (T cell
- depletion). If the condition nevertheless develops, it can occur soon after the return of white cells (acute
- graft-versus-host disease) or much later (chronic graft-versus-host disease).
- The two types are similar in some ways, though each has distinctive features. The acute form often doesn't
- last long but can be quite severe. If it is severe, the prognosis for survival is very poor. Chronic
- graft-versus-host disease almost always requires therapy, and most patients recover. One positive note is that
