Early onset of acute immune‐mediated lung injury in a child undergoing allogeneic peripheral blood transplantation

Abstract

Animal models have recently clarified the lung injury after 1 allogeneic hematopoietic transplantation. These works have confirmed the role of donor T lymphocytes in immunemediated inflammatory reactions in the lung. We report here a fatal case of a 3-year-old child who developed acute respiratory failure coinciding with the onset of hyper-acute graft versus host disease (aGVHD) after allogeneic peripheral stem cell transplantation. aGVHD was refractory to treatment and the patient died on day +28. Lung necropsy showed interstitial pneumonia and peribronchial and perivascular infiltration by mononuclear cells, with no viral inclusions. These findings are not specific but have been found by some authors in animal models with acute immune-mediated lung injury related with donor T lymphocytes. Immune-mediated lung injury, as defined by animal models, should be considered in patients with severe signs of systemic aGVHD while excluding other known etiologies of pulmonary disease. Am.

Increase of interleukin-18 serum levels after engraftment correlates with acute graft-versus-host disease in allogeneic peripheral blood stem cell transplantation

“…Arndt et al could demonstrate that acute toxic, but not hemorrhagic lung damage, can lead to IL-18 increases comparable to observations during acute GvHD [29]. Furthermore, in spite of the conventional classification of acute GvHD according to Thomas et al, recent literature supports the idea that non-infectious ARDS after transplantation can belong to GvHD-related events and vice versa [1,2,3,28]. Thus, we suggest that IL-18 increases during ARDS post-transplantation in one patient reflect such non-classical manifestation of acute GvHD.…”

“…Total grade of acute GvHD was divided into four groups (grade I-IV). Furthermore, non-infectious lung disease, such as ARDS-isolated or in combination with classic manifestations of GvHD according to Thomas-were also considered as acute GvHD (high grade) [2,3,28]. The only patient with ARDS after PBSCT developed a GvHD of skin shortly after the ARDS.…”

Pulmonary dysfunction in pediatric hematopoietic stem cell transplant patients: Non‐infectious and long‐term complications

“…Pulmonary involvement during acute GVHD tends to be minimal 4; nonetheless, a number of potential histopathological correlates, including PCT and lymphocytic bronchitis/bronchiolitis (Fig. 2), have been identified 49,65–68. Unlike acute GVHD, chronic GVHD is associated with significant pulmonary pathology 4.…”

Donor immune reconstitution after liver–small bowel transplantation for multiple intestinal atresia with immunodeficiency

“…Since discharge he has had chronic lung disease related to multiple pneumonias (including parainfluenza), tracheomalacia, and possible pulmonary GVHD. 10 Recurrent CMV disease of the gastrointestinal tract, mild to moderate skin GVHD, and iatrogenic Cushing syndrome have also developed.…”