Graft-Versus-Host Reaction in the Lung

Stein‐Streilein, Joan; Lipscomb, Mary F.; Hart, David A.; Darden, Alix G.

doi:10.1097/00007890-198107000-00008

Cited by 25 publications

(11 citation statements)

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“…Despite different methods to develop models for lung allografting or GVHD, the immunologic responses in the lung show similar histologic patterns. Several studies have documented these similarities (Atkinson et al, 1971;Emeson et al, 1982;Piguet et al, 1989b;Randhawa and Yousen, 1992;Stein-Streilein et al, 1981;Yousem et al, 1990). The histoincompatible allografted lung is recognized as "foreign" by the recipient and, therefore, is subject to rejection (Randhawa and Yousem, 1992).…”

Section: A Lung Allograft Rejection and Graft Versus Host Diseasementioning

confidence: 91%

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The Regulation of Pulmonary Immunity

Lipscomb

Bice²,

Lyons

et al. 1995

Advances in Immunology

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Section: A Lung Allograft Rejection and Graft Versus Host Diseasementioning

confidence: 91%

“…In animal models, investigators have reported acute "GVHD-like" changes in the lung (Piguet et al, 1989b; Stein-Streilein et al, 1981;Wilkes et al, 1994a). In these studies the histologic lesions included alveolitis, lymphocytic bronchitis, and vasculitis.…”

Section: A Lung Allograft Rejection and Graft Versus Host Diseasementioning

confidence: 99%

The Regulation of Pulmonary Immunity

Lipscomb

Bice²,

Lyons

et al. 1995

Advances in Immunology

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“…Biopsy specimens usually demonstrate bronchiolitis involving the small airways and fibrinous obliteration of the lumen of the respiratory bronchioles, with or without associated interstitial pneumonia, fibrosis, or diffuse alveolar damage; inflammatory cell infiltrates consisting of neutrophils and mononuclear cells, the former more often in the lumens of the affected bronchioles, are prominent early in the disease process. [18,19] In the chronic phase, there are variable degrees of intralumenal or peribronchiolar fibrosis, ranging from proliferation of fibroblasts and myofibroblasts to collagen scarring. This leads to progressive circumferential fibrosis and ultimate cicatrization of the small terminal airways, manifesting as new fixed airflow obstruction.…”

Section: Epidemiology and Pathogenesis Of Broncholitis Obliterans Aftmentioning

confidence: 99%

“…Unfortunately, all of these studies have been conducted using mouse models of host versus graft disease, which is more representative of lung transplantation. [18,20–24]…”

Section: Epidemiology and Pathogenesis Of Broncholitis Obliterans Aftmentioning

confidence: 99%

Bronchiolitis Obliterans Syndrome After Allogeneic Hematopoietic Stem Cell Transplantation—An Increasingly Recognized Manifestation of Chronic Graft-versus-Host Disease

Chien

Duncan

Williams

et al. 2010

Biology of Blood and Marrow Transplantation

167

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Bronchiolitis obliterans syndrome (BOS) is a progressive, insidious, and often fatal lung allo-reaction that can occur following allogeneic hematopoietic stem cell transplantation (HCT) or allogeneic lung transplantation. Current estimates in the literature suggest that approximately 2–3% of all allogeneic HCT recipients and 6% of patients who develop chronic GVHD will develop this syndrome. However, based on newer data it is likely that the true incidence of BOS is higher. Unfortunately, the survival and treatment of patients with BOS after HCT has not improved over the last 20 years. Attempts at clinical trials have been hindered by the lack of uniform diagnostic criteria and inability to detect the syndrome at a reversible stage in its natural history. Recently, the NIH consensus project for criteria in chronic GVHD has made recommendations regarding the diagnosis of BOS and monitoring of lung disease among long term survivors. Although a rare and poorly understood manifestation of chronic GVHD, BOS occurs commonly after lung transplantation and is similar in pathology, clinical presentation, radiographic presentation, and presumed immunologic pathogenesis. This review describes the current understanding of the epidemiology and pathogenesis of BOS and presents information on evaluations and therapies for patients with BOS after HCT.

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“…Patients with primary hypogammaglobulinemia get bronchiectasis and OAD but not the pathological picture seen in BMT (10). The only models in which bronchiolitis obliterans in experimental animals is reproducible involve clinically irrelevant methods such as intratracheal instillation of activated T cells (11). A model of GVHD in immunodeficient C.B-17-scid mice, where effects of conditioning and infection are minimized (12), also does not show any lung involvement in GVHD.…”

Section: Discussionmentioning

confidence: 99%

Association of Human Lymphocyte Antigens with Obstructive Airways Disease after Bone Marrow Transplantation

Spaner¹,

Lipton²,

Chan³

1996

Canadian Respiratory Journal

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BACKGROUND: Obstructive airways disease (OAD) is a known complication of allogeneic bone marrow transplantation. The etiology of OAD is unknown but is probably multifactorial. The identification of a significant human lymphocyte antigen (HLA) association with the development of OAD might offer some insight into its pathogenesis and serve as a marker to identify prospectively patients at risk for developing OAD. OBJECTIVE: The major histocompatibility antigen (MHC) associations of OAD post-allogeneic bone marrow transplantation were studied to determine whether particular subsets of patients are more susceptible to this syndrome. POPULATION: Twenty-one of 244 consecutive patients with allogeneic transplants performed between 1980 and 1987 were identified as developing OAD after having had normal pulmonary function tests before transplant. Thirtynine controls were selected on the basis of normal pulmonary function tests pre-and post-transplant and comparable follow-up periods. METHODS:The study was a retrospective case-control study. Gene frequencies of the HLA-A and -B types in the patients and controls were compared and a relative risk of OAD with a given HLA allele was calculated. RESULTS: There was a significant correlation of the development of OAD with the presence of the MHC antigen, 45). CONCLUSIONS: These data support the idea that patients who express the 45) antigen are at higher risk for the development of OAD post bone marrow transplantation. However, the findings are based on retrospective analysis and accordingly should be considered tentative until followed by larger and preferably prospective studies to confirm the findings. A irways obstruction has been reported in approximately 10% of allogeneic bone marrow transplant (BMT) recipients (1-3). The pathology of the disease is thought to be the same as for bronchiolitis obliterans, although pathological material is not available in all patients. This lung disease is thought to be a manifestation of chronic graft-versus-host disease (GVHD) through an immunological attack on lung epithelium. Other pathogenic mechanisms have not been ruled out. For example, obstructive airways disease (OAD) may be due to a persistent viral infection in the immunodeficient state of chronic GVHD, to recurrent aspiration from esophageal involvement in chronic GVHD, or to drug or radiation toxicity from the preparative regimen before BMT.The identification of a significant human lymphocyte antigen (HLA) association with the development of OAD might offer some insight into its pathogenesis. Diseases with specific HLA associations are felt to be 'autoimmune' in nature (4). Alternatively, HLA molecules may not be able to present peptides from microbial proteins with the result that an infectious process can proceed unchecked (4).A significant HLA association might also serve as a marker to identify prospectively those patients who are at risk for developing OAD and to allow for prediction of the severity of the ensuing disease.For these reasons, the HLA types of patients wit...

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Graft-Versus-Host Reaction in the Lung

Cited by 25 publications

References 0 publications

The Regulation of Pulmonary Immunity

The Regulation of Pulmonary Immunity

Bronchiolitis Obliterans Syndrome After Allogeneic Hematopoietic Stem Cell Transplantation—An Increasingly Recognized Manifestation of Chronic Graft-versus-Host Disease

Association of Human Lymphocyte Antigens with Obstructive Airways Disease after Bone Marrow Transplantation

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