The diffuse alveolar hemorrhage syndrome, recently reported in recipients of autologous bone marrow transplants, is characterized by progressive dyspnea, hypoxia, diffuse consolidation on chest roentgenogram, and bloody fluid on bronchoalveolar lavage. The incidence was 21% to 35% and the mortality was 80% to 100% in two series. We diagnosed four cases of diffuse alveolar hemorrhage in 77 patients who had received autologous bone marrow transplants for lymphoma (incidence of 5%). All patients were diagnosed within 24 hours of the onset of symptoms and were subsequently treated with high-dose methylprednisolone therapy, 1 g/d for 3 days. The dosage was then tapered by 50% every 3 days down to a dose of 60 mg/d. It was then gradually tapered off over 2 months. The conditions of all 4 patients improved, and the patients were discharged from the hospital. Three of the four patients are alive and well from 3 to 17 months after transplantation. No patients developed infectious complications secondary to the high-dose corticosteroid treatment. One patient died from graft-versus-host disease after receiving an allogeneic graft from his HLA-identical sibling for autologous graft failure. This small series suggests that, when recognized promptly, diffuse alveolar hemorrhage can be successfully treated with high doses of corticosteroids.
