Table 1– Patient and therapy characteristics
PatientIndicationAge yrsSexTX type#Time after TX monthsDiagnosisHRCT observationsPre-fludarabine virologyTime after TX of first fludarabine monthsCourses of fludarabine nResponse of nonspecific inflammatory lung injuryT-cellsPost-fludarabine virologyOutcome
1Relapsed infant ALL2FHSCT Cord 05/062AIP>BOSMosaic attenuation without air trapping, ground-glass opacities, tree-in-bud sign, small centrilobular nodules, septal linesBAL and NPA: RV (CT 17)64Positive clinical responseCD3 values returned to normal after 13 monthsBAL: RV (CT 19)Died of disease (1.5 yrs after last fludarabine)
2JMML1FHSCT Cord 05/062IPSBilateral consolidations with ground-glass opacitiesBAL and NPA: Ad (CT 22)44Positive clinical responseCD3 values normalised at 25 monthsNPA: negativeAlive 3 yrs after last fludarabine
3Hurler syndrome (tracheomalacia)1MHSCT Cord 04/062AIP>BOSGround-glass opacities, small nodules (halo), some air trapping (also seen on the pre-HSCT HRCT)BAL and NPA: negative32Partial clinical response after primary respiratory insufficiencyCD3 values normalised after 8 monthsBAL: negativeAlive 2 yrs after last fludarabine
4Cutaneous lymphoma associated with CID15MHSCT MUD 09/108IPS>BOOPDiffuse infiltrates mainly located peripherallyBAL: RV (CT 18) and galactomannan10.54Positive clinical responseNo normalisation in T-cell valuesBAL and NPA: negativeDied of lymphoma and CID, 5 months after last fludarabine
  • TX: transplant; HRCT: high-resolution computed tomography; ALL: acute lymphatic leukaemia; JMML: juvenile myelomonocytic leukaemia; CID: combined immunodeficiency; F: female; M: male; HSCT: haematopoietic stem cell transplantation; Cord: cord blood transplantation; MUD: matched, unrelated donor; AIP: acute interstitial pneumonitis; >: progression to; BOS: bronchiolitis obliterans syndrome; IPS: idiopathic pneumonia syndrome; BOOP: bronchiolitis obliterans organising pneumonia; BAL; bronchoalveolar lavage; NPA: nasopharyngeal aspirate; RV: rhinovirus; CT: threshold cycle; Ad: adenovirus. #: numbers refer to grade of HLA mismatch.