Managing bone marrow transplant patients

Oncology therapies are rapidly proliferating, and increasing numbers of patients are undergoing hematopoietic stem cell transplantation for hematologic and oncologic disorders, according to Kyle Brownback, MD, FCCP, of the University of Kansas Medical Center. These patients often receive care at specialized centers but then develop complications after returning home, thereby necessitating care by ICU providers who may be less familiar with their complex needs. In the session Intensive Care Management of Bone Marrow Transplant Patients on Wednesday at 2:15 pm in room 287 of the convention center, Dr. Brownback and his co-presenters will use clinical cases to illustrate unique and critical complications of oncology therapies and stem cell transplantation. Dr. Brownback gives a glimpse into the session in this Q&A with Daily News.

What was the impetus for your session?

→ More and more patients are undergoing bone marrow transplantation or advanced cellular therapies to treat and cure their hematologic malignancies. With these treatments, the lungs can be affected and injured during the normal treatment course. We felt it necessary to explore the possible manifestations of pulmonary disease in these patients and how we can best diagnose and manage them.

Can you speak to how oncology therapies are proliferating?

→ The treatments of hematologic and solid tumor malignancies have exploded in the past decade, with patients having treatment options where they once had none. With these new treatments come potentials for toxicities and side effects involving the lungs. Only with further study and rigorous review of clinical trial data can we be prepared to effectively diagnose and treat these patients.

What are some of the complications patients develop after receiving some of these therapies? What are some of the therapies you’ll be addressing?

→ We will be addressing many different aspects in the spectrum of management of patients with hematologic malignancies, including identifying and managing infectious complications, management of pulmonary drug toxicities, management of chronic pulmonary graft vs host disease (GvHD), and management of ICU complications following bone marrow transplant.

What will you be reviewing in order for attendees to come away from the session knowing how to craft a differential diagnosis and diagnostic approach?

→ We will be reviewing our approach to these patients with history of hematologic malignancies, how to identify infectious etiologies vs drug toxicities vs other conditions on the spectrum of illness. We will be discussing use of pulmonary function testing, bronchoscopy, and biopsy in this patient population.

What are some of the management strategies in this complex patient population? Why are they so complex?

→ These patients are complex in that some may be immunosuppressed and increased risk for infection, whereas others may be receiving immune checkpoint inhibitors and actually have a hypervigilent immune system. In patients with GvHD, their immune system may be overactive and causing damage to the lungs, which may also be putting them at risk for infection. In these conditions, there may be significant overlap in symptoms and imaging, making it quite the diagnostic challenge.

What are a couple of takeaways you want attendees to come away with after the session?

→ How to properly approach these patients, consider all of the diagnostic possibilities, and how to properly manage your patients while exposing them to as little risk as possible.


We felt it necessary to explore the possible manifestations of pulmonary disease in these patients and how we can best diagnose and manage them.

Kyle Brownback, MD, FCCP,