{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T18:31:58Z","timestamp":1774117918642,"version":"3.50.1"},"reference-count":80,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Context.<\/jats:italic>\n                    \u2014Bone marrow transplantation (BMT) is used to treat various malignant and nonmalignant disorders. Pulmonary complications are some of the most common causes of mortality in BMT recipients. Poor general health and bleeding tendency frequently preclude the use of definitive diagnostic tests, such as open lung biopsy, in these patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Objective.<\/jats:italic>\n                    \u2014To identify pulmonary complications after BMT and their role as the cause of death (COD).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Design.<\/jats:italic>\n                    \u2014The autopsy and bronchoalveolar lavage (BAL) slides and microbiology studies of BMT recipients from a 7-year period were reviewed.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Results.<\/jats:italic>\n                    \u2014Pulmonary complications were identified in 40 (80%) of the 50 cases. The most common complications were diffuse alveolar damage (DAD) and diffuse alveolar hemorrhage (DAH). Pulmonary complications were the sole or 1 of multiple CODs in 37 cases (74%). All complications were more common in allogeneic BMT recipients. In 19 (51%) of the 37 cases in which pulmonary complications contributed to the death, cultures were negative. Both DAD and DAH, complications commonly reported in the early post-BMT period, were seen more than 100 days after BMT in 33% and 12% of cases, respectively. Five (83%) of 6 cases of invasive pulmonary aspergillosis diagnosed at autopsy were negative for fungi ante mortem (by BAL and cultures).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions.<\/jats:italic>\n                    \u2014Pulmonary complications are a significant COD in BMT recipients, many of which, especially the fungal infections, are difficult to diagnose ante mortem. The etiology of DAD and DAH is likely to be multifactorial, and these complications are not limited to the early posttransplantation period. Autopsy examination is important in determining the COD in BMT recipients.\n                  <\/jats:p>","DOI":"10.5858\/2005-129-366-pcabmt","type":"journal-article","created":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T20:33:46Z","timestamp":1612989226000},"page":"366-371","source":"Crossref","is-referenced-by-count":77,"title":["Pulmonary Complications After Bone Marrow Transplantation: An Autopsy Study From a Large Transplantation Center"],"prefix":"10.5858","volume":"129","author":[{"given":"Monika","family":"Roychowdhury","sequence":"first","affiliation":[{"name":"From the University of Minnesota Medical School, Fairview-University Medical Center, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan E.","family":"Pambuccian","sequence":"additional","affiliation":[{"name":"From the University of Minnesota Medical School, Fairview-University Medical Center, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deniz L.","family":"Aslan","sequence":"additional","affiliation":[{"name":"From the University of Minnesota Medical School, Fairview-University Medical Center, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Jessurun","sequence":"additional","affiliation":[{"name":"From the University of Minnesota Medical School, Fairview-University Medical Center, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan G.","family":"Rose","sequence":"additional","affiliation":[{"name":"From the University of Minnesota Medical School, Fairview-University Medical Center, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Carlos","family":"Manivel","sequence":"additional","affiliation":[{"name":"From the University of Minnesota Medical School, Fairview-University Medical Center, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. Evin","family":"Gulbahce","sequence":"additional","affiliation":[{"name":"From the University of Minnesota Medical School, Fairview-University Medical Center, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3906","reference":[{"key":"i1543-2165-129-3-366-b1","series-title":"Cancer","first-page":"1047","article-title":"Pulmonary complications occurring after allogeneic bone marrow transplantation: a study of 130 consecutive transplanted patients.","volume":"58","author":"Cordonnier, C.","year":"1986","unstructured":"Cordonnier, C., J. F.Bernaudin, P.Bierling, Y.Huet, and J. P.Vernant. Pulmonary complications occurring after allogeneic bone marrow transplantation: a study of 130 consecutive transplanted patients.Cancer1986. 58:1047\u20131054."},{"key":"i1543-2165-129-3-366-b2","series-title":"Br J Haematol","first-page":"680","article-title":"Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation.","volume":"100","author":"Palmas, A.","year":"1998","unstructured":"Palmas, A., A.Tefferi, and J. L.Myers. et al. Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation.Br J Haematol1998. 100:680\u2013687."},{"key":"i1543-2165-129-3-366-b3","series-title":"Br J Haematol","first-page":"3","article-title":"Non-endocrine late complications of bone marrow transplantation in childhood: part I.","volume":"118","author":"Leiper, A. D.","year":"2002","unstructured":"Leiper, A. D.\n          \n          Non-endocrine late complications of bone marrow transplantation in childhood: part I.\n          Br J Haematol\n          2002. 118:3\u201322."},{"key":"i1543-2165-129-3-366-b4","series-title":"Chest","first-page":"333","article-title":"Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer.","volume":"119","author":"Dunagan, D.","year":"2001","unstructured":"Dunagan, D., R. JrChin, and T.McCain. et al. Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer.Chest2001. 119:333\u2013339."},{"key":"i1543-2165-129-3-366-b5","series-title":"Bone Marrow Transplant","first-page":"63","article-title":"The safety and usefulness of routine bronchoscopy before stem cell transplantation and during neutropenia.","volume":"24","author":"Whittle, A. T.","year":"1999","unstructured":"Whittle, A. T., M.Davis, P. R.Johnson, R. C.Leonard, and A. P.Greening. The safety and usefulness of routine bronchoscopy before stem cell transplantation and during neutropenia.Bone Marrow Transplant1999. 24:63\u201367."},{"key":"i1543-2165-129-3-366-b6","series-title":"J Pediatr Surg","first-page":"533","article-title":"The usefulness of open-lung biopsy in the pediatric bone marrow transplant population.","volume":"23","author":"Shorter, N. A.","year":"1988","unstructured":"Shorter, N. A., A. J. I. I. I.Ross, and C.August. et al. The usefulness of open-lung biopsy in the pediatric bone marrow transplant population.J Pediatr Surg1988. 23:533\u2013537."},{"key":"i1543-2165-129-3-366-b7","series-title":"J Pediatr Surg","first-page":"871","article-title":"Diagnostic open-lung biopsy after bone marrow transplantation.","volume":"25","author":"Snyder, C. L.","year":"1990","unstructured":"Snyder, C. L., N. K.Ramsay, P. B.McGlave, K. L.Ferrell, and A. S.Leonard. 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Pulmonary complications following bone marrow transplantation.Br J Radiol2003. 76:373\u2013379."},{"key":"i1543-2165-129-3-366-b10","series-title":"Hematol Oncol Clin North Am","first-page":"887","article-title":"Approach to the immunocompromised host with pulmonary symptoms.","volume":"7","author":"Dichter, J. R.","year":"1993","unstructured":"Dichter, J. R., S. J.Levine, and J. H.Shelhamer. Approach to the immunocompromised host with pulmonary symptoms.Hematol Oncol Clin North Am1993. 7:887\u2013912."},{"key":"i1543-2165-129-3-366-b11","series-title":"Arch Pathol Lab Med","first-page":"125","article-title":"Main autopsy findings in bone marrow transplant patients.","volume":"111","author":"Bombi, J. A.","year":"1987","unstructured":"Bombi, J. A., A.Cardesa, and C.Llebaria. et al. Main autopsy findings in bone marrow transplant patients.Arch Pathol Lab Med1987. 111:125\u2013129."},{"key":"i1543-2165-129-3-366-b12","series-title":"Am J Clin Pathol","first-page":"335","article-title":"Autopsy findings in umbilical cord blood transplant recipients.","volume":"112","author":"Nuckols, J. D.","year":"1999","unstructured":"Nuckols, J. D.\n          \n          Autopsy findings in umbilical cord blood transplant recipients.\n          Am J Clin Pathol\n          1999. 112:335\u2013342."},{"key":"i1543-2165-129-3-366-b13","series-title":"Bone Marrow Transplant","first-page":"675","article-title":"Autopsy-identified infections among bone marrow transplant recipients: a clinicopathologic study of 56 patients.","volume":"16","author":"Chandrasekar, P. H.","year":"1995","unstructured":"Chandrasekar, P. H., A.Weinmann, and C.Shearer. Autopsy-identified infections among bone marrow transplant recipients: a clinicopathologic study of 56 patients.Bone Marrow Transplant1995. 16:675\u2013681."},{"key":"i1543-2165-129-3-366-b14","series-title":"Bone Marrow Transplant","first-page":"539","article-title":"Increasing incidence of diffuse alveolar hemorrhage following allogeneic bone marrow transplantation: cryptic etiology and uncertain therapy.","volume":"26","author":"Lewis, I. D.","year":"2000","unstructured":"Lewis, I. D., T.DeFor, and D. J.Weisdorf. Increasing incidence of diffuse alveolar hemorrhage following allogeneic bone marrow transplantation: cryptic etiology and uncertain therapy.Bone Marrow Transplant2000. 26:539\u2013543."},{"key":"i1543-2165-129-3-366-b15","series-title":"Leukemia","first-page":"1049","article-title":"Diffuse alveolar hemorrhage: an evolving problem?","volume":"17","author":"Weisdorf, D. J.","year":"2003","unstructured":"Weisdorf, D. J.\n          \n          Diffuse alveolar hemorrhage: an evolving problem?\n          Leukemia\n          2003. 17:1049\u20131050."},{"key":"i1543-2165-129-3-366-b16","series-title":"Am J Respir Crit Care Med","first-page":"1006","article-title":"Diffuse alveolar hemorrhage in allogeneic bone marrow transplantation: a postmortem study.","volume":"151","author":"Agusti, C.","year":"1995","unstructured":"Agusti, C., J.Ramirez, and C.Picado. et al. Diffuse alveolar hemorrhage in allogeneic bone marrow transplantation: a postmortem study.Am J Respir Crit Care Med1995. 151:1006\u20131010."},{"key":"i1543-2165-129-3-366-b17","series-title":"Chest","first-page":"660","article-title":"Diffuse alveolar hemorrhage following allogeneic bone marrow transplantation in children.","volume":"124","author":"Ben-Abraham, R.","year":"2003","unstructured":"Ben-Abraham, R., G.Paret, and R.Cohen. et al. Diffuse alveolar hemorrhage following allogeneic bone marrow transplantation in children.Chest2003. 124:660\u2013664."},{"key":"i1543-2165-129-3-366-b18","series-title":"Am J Respir Crit Care Med","first-page":"157","article-title":"Alveolar hemorrhage: diagnostic criteria and results in 194 immunocompromised hosts.","volume":"151","author":"De Lassence, A.","year":"1995","unstructured":"De Lassence, A., J.Fleury-Feith, E.Escudier, J.Beaune, J. F.Bernaudin, and C.Cordonnier. Alveolar hemorrhage: diagnostic criteria and results in 194 immunocompromised hosts.Am J Respir Crit Care Med1995. 151:157\u2013163."},{"key":"i1543-2165-129-3-366-b19","series-title":"Am J Med","first-page":"511","article-title":"Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients.","volume":"87","author":"Robbins, R. A.","year":"1989","unstructured":"Robbins, R. A., J.Linder, and M. G.Stahl. et al. Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients.Am J Med1989. 87:511\u2013518."},{"key":"i1543-2165-129-3-366-b20","series-title":"Clin Chest Med","first-page":"323","article-title":"Pulmonary complications following bone marrow transplantation.","volume":"11","author":"Chan, C. K.","year":"1990","unstructured":"Chan, C. K., R. H.Hyland, and M. A.Hutcheon. Pulmonary complications following bone marrow transplantation.Clin Chest Med1990. 11:323\u2013332."},{"key":"i1543-2165-129-3-366-b21","series-title":"Transplantation","first-page":"88","article-title":"Pulmonary hemorrhage as a cause of death in allogeneic bone marrow recipients with severe acute graft-versus-host disease.","volume":"57","author":"Wojno, K. J.","year":"1994","unstructured":"Wojno, K. J., G. B.Vogelsang, W. E.Beschorner, and G. W.Santos. Pulmonary hemorrhage as a cause of death in allogeneic bone marrow recipients with severe acute graft-versus-host disease.Transplantation1994. 57:88\u201392."},{"key":"i1543-2165-129-3-366-b22","series-title":"Blood","first-page":"2208","article-title":"Risk of lymphoproliferative disorders after bone marrow transplantation: a multi-institutional study.","volume":"94","author":"Curtis, R. E.","year":"1999","unstructured":"Curtis, R. E., L. B.Travis, and P. A.Rowlings. et al. Risk of lymphoproliferative disorders after bone marrow transplantation: a multi-institutional study.Blood1999. 94:2208\u20132216."},{"key":"i1543-2165-129-3-366-b23","series-title":"Transpl Int","first-page":"S382","article-title":"Incidence and clinical characteristics of posttransplant lymphoproliferative disorders: report from a single center.","volume":"13","author":"Muti, G.","year":"2000","unstructured":"Muti, G., A.De Gasperi, and S.Cantoni. et al. Incidence and clinical characteristics of posttransplant lymphoproliferative disorders: report from a single center.Transpl Int2000. 13:(suppl 1). S382\u2013S387."},{"key":"i1543-2165-129-3-366-b24","series-title":"J Clin Oncol","first-page":"348","article-title":"New malignant diseases after allogeneic marrow transplantation for childhood acute leukemia.","volume":"18","author":"Socie, G.","year":"2000","unstructured":"Socie, G., R. E.Curtis, and H. J.Deeg. et al. New malignant diseases after allogeneic marrow transplantation for childhood acute leukemia.J Clin Oncol2000. 18:348\u2013357."},{"key":"i1543-2165-129-3-366-b25","series-title":"Am J Surg Pathol","first-page":"1147","article-title":"Pulmonary cytolytic thrombi: a previously unrecognized complication of bone marrow transplantation.","volume":"24","author":"Gulbahce, H. E.","year":"2000","unstructured":"Gulbahce, H. E., J. C.Manivel, and J.Jessurun. 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Lymphocytic bronchitis associated with graft-versus-host disease in recipients of bone-marrow transplants.N Engl J Med1978. 299:1030\u20131036."},{"key":"i1543-2165-129-3-366-b34","series-title":"Blood","first-page":"3212","article-title":"Obstructive lung disease in children after allogeneic bone marrow transplantation.","volume":"84","author":"Schultz, K. R.","year":"1994","unstructured":"Schultz, K. R., G. J.Green, and D.Wensley. et al. Obstructive lung disease in children after allogeneic bone marrow transplantation.Blood1994. 84:3212\u20133220."},{"key":"i1543-2165-129-3-366-b35","series-title":"J Clin Pathol","first-page":"546","article-title":"Histopathology of the lung after bone marrow transplantation.","volume":"36","author":"Sloane, J. P.","year":"1983","unstructured":"Sloane, J. P., M. H.Depledge, R. L.Powles, G. R.Morgenstern, B. S.Trickey, and P. J.Dady. Histopathology of the lung after bone marrow transplantation.J Clin Pathol1983. 36:546\u2013554."},{"key":"i1543-2165-129-3-366-b36","series-title":"Blood","first-page":"3373","article-title":"Nonmalignant late effects after allogeneic stem cell transplantation.","volume":"101","author":"Socie, G.","year":"2003","unstructured":"Socie, G., N.Salooja, and A.Cohen. et al. Nonmalignant late effects after allogeneic stem cell transplantation.Blood2003. 101:3373\u20133385."},{"key":"i1543-2165-129-3-366-b37","series-title":"Postgrad Med J","first-page":"257","article-title":"Non-infectious pulmonary complications after bone marrow transplantation.","volume":"78","author":"Khurshid, I.","year":"2002","unstructured":"Khurshid, I. and L. C.Anderson. Non-infectious pulmonary complications after bone marrow transplantation.Postgrad Med J2002. 78:257\u2013262."},{"key":"i1543-2165-129-3-366-b38","series-title":"Blood","first-page":"4236","article-title":"Late-onset noninfectious pulmonary complications after allogeneic stem cell transplantation are significantly associated with chronic graft-versus-host disease and with the graft-versus-leukemia effect.","volume":"102","author":"Sakaida, E.","year":"2003","unstructured":"Sakaida, E., C.Nakaseko, and A.Harima. et al. Late-onset noninfectious pulmonary complications after allogeneic stem cell transplantation are significantly associated with chronic graft-versus-host disease and with the graft-versus-leukemia effect.Blood2003. 102:4236\u20134242."},{"key":"i1543-2165-129-3-366-b39","series-title":"Pediatr Pulmonol","first-page":"393","article-title":"Pulmonary complications after bone marrow transplantation in children: twenty-four years of experience in a single pediatric center.","volume":"30","author":"Griese, M.","year":"2000","unstructured":"Griese, M., U.Rampf, D.Hofmann, M.Fuhrer, D.Reinhardt, and C.Bender-Gotze. Pulmonary complications after bone marrow transplantation in children: twenty-four years of experience in a single pediatric center.Pediatr Pulmonol2000. 30:393\u2013401."},{"key":"i1543-2165-129-3-366-b40","series-title":"Ann Hematol","first-page":"S11","article-title":"Non-infectious lung complications after transplantation.","volume":"81","author":"Paul, K.","year":"2002","unstructured":"Paul, K.\n          \n          Non-infectious lung complications after transplantation.\n          Ann Hematol\n          2002. 81:(suppl 2). S11\u2013S16."},{"key":"i1543-2165-129-3-366-b1","series-title":"Cancer","first-page":"1047","article-title":"Pulmonary complications occurring after allogeneic bone marrow transplantation: a study of 130 consecutive transplanted patients.","volume":"58","author":"Cordonnier, C.","year":"1986","unstructured":"Cordonnier, C., J. F.Bernaudin, P.Bierling, Y.Huet, and J. P.Vernant. Pulmonary complications occurring after allogeneic bone marrow transplantation: a study of 130 consecutive transplanted patients.Cancer1986. 58:1047\u20131054."},{"key":"i1543-2165-129-3-366-b2","series-title":"Br J Haematol","first-page":"680","article-title":"Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation.","volume":"100","author":"Palmas, A.","year":"1998","unstructured":"Palmas, A., A.Tefferi, and J. L.Myers. et al. Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation.Br J Haematol1998. 100:680\u2013687."},{"key":"i1543-2165-129-3-366-b3","series-title":"Br J Haematol","first-page":"3","article-title":"Non-endocrine late complications of bone marrow transplantation in childhood: part I.","volume":"118","author":"Leiper, A. D.","year":"2002","unstructured":"Leiper, A. D.\n          \n          Non-endocrine late complications of bone marrow transplantation in childhood: part I.\n          Br J Haematol\n          2002. 118:3\u201322."},{"key":"i1543-2165-129-3-366-b4","series-title":"Chest","first-page":"333","article-title":"Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer.","volume":"119","author":"Dunagan, D.","year":"2001","unstructured":"Dunagan, D., R. JrChin, and T.McCain. et al. Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer.Chest2001. 119:333\u2013339."},{"key":"i1543-2165-129-3-366-b5","series-title":"Bone Marrow Transplant","first-page":"63","article-title":"The safety and usefulness of routine bronchoscopy before stem cell transplantation and during neutropenia.","volume":"24","author":"Whittle, A. T.","year":"1999","unstructured":"Whittle, A. T., M.Davis, P. R.Johnson, R. C.Leonard, and A. P.Greening. The safety and usefulness of routine bronchoscopy before stem cell transplantation and during neutropenia.Bone Marrow Transplant1999. 24:63\u201367."},{"key":"i1543-2165-129-3-366-b6","series-title":"J Pediatr Surg","first-page":"533","article-title":"The usefulness of open-lung biopsy in the pediatric bone marrow transplant population.","volume":"23","author":"Shorter, N. A.","year":"1988","unstructured":"Shorter, N. A., A. J. I. I. I.Ross, and C.August. et al. The usefulness of open-lung biopsy in the pediatric bone marrow transplant population.J Pediatr Surg1988. 23:533\u2013537."},{"key":"i1543-2165-129-3-366-b7","series-title":"J Pediatr Surg","first-page":"871","article-title":"Diagnostic open-lung biopsy after bone marrow transplantation.","volume":"25","author":"Snyder, C. L.","year":"1990","unstructured":"Snyder, C. L., N. K.Ramsay, P. B.McGlave, K. L.Ferrell, and A. S.Leonard. Diagnostic open-lung biopsy after bone marrow transplantation.J Pediatr Surg1990. 25:871\u2013876. discussion 876\u2013877."},{"key":"i1543-2165-129-3-366-b8","series-title":"Am J Respir Crit Care Med","first-page":"641","article-title":"Diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients.","volume":"166","author":"Afessa, B.","year":"2002","unstructured":"Afessa, B., A.Tefferi, M. R.Litzow, M. J.Krowka, M. E.Wylam, and S. G.Peters. Diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients.Am J Respir Crit Care Med2002. 166:641\u2013645."},{"key":"i1543-2165-129-3-366-b9","series-title":"Br J Radiol","first-page":"373","article-title":"Pulmonary complications following bone marrow transplantation.","volume":"76","author":"Wah, T. M.","year":"2003","unstructured":"Wah, T. M., H. A.Moss, R. J.Robertson, and D. L.Barnard. Pulmonary complications following bone marrow transplantation.Br J Radiol2003. 76:373\u2013379."},{"key":"i1543-2165-129-3-366-b10","series-title":"Hematol Oncol Clin North Am","first-page":"887","article-title":"Approach to the immunocompromised host with pulmonary symptoms.","volume":"7","author":"Dichter, J. R.","year":"1993","unstructured":"Dichter, J. R., S. J.Levine, and J. H.Shelhamer. Approach to the immunocompromised host with pulmonary symptoms.Hematol Oncol Clin North Am1993. 7:887\u2013912."},{"key":"i1543-2165-129-3-366-b11","series-title":"Arch Pathol Lab Med","first-page":"125","article-title":"Main autopsy findings in bone marrow transplant patients.","volume":"111","author":"Bombi, J. A.","year":"1987","unstructured":"Bombi, J. A., A.Cardesa, and C.Llebaria. et al. Main autopsy findings in bone marrow transplant patients.Arch Pathol Lab Med1987. 111:125\u2013129."},{"key":"i1543-2165-129-3-366-b12","series-title":"Am J Clin Pathol","first-page":"335","article-title":"Autopsy findings in umbilical cord blood transplant recipients.","volume":"112","author":"Nuckols, J. D.","year":"1999","unstructured":"Nuckols, J. D.\n          \n          Autopsy findings in umbilical cord blood transplant recipients.\n          Am J Clin Pathol\n          1999. 112:335\u2013342."},{"key":"i1543-2165-129-3-366-b13","series-title":"Bone Marrow Transplant","first-page":"675","article-title":"Autopsy-identified infections among bone marrow transplant recipients: a clinicopathologic study of 56 patients.","volume":"16","author":"Chandrasekar, P. H.","year":"1995","unstructured":"Chandrasekar, P. H., A.Weinmann, and C.Shearer. 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