Lymphocytic Bronchitis Associated with Graft-versus-Host Disease in Recipients of Bone-Marrow Transplants

Abstract

Graft-versus-host disease, a complication of allogeneic bone-marrow transplantation, involves primarily the skin, liver and intestines, but may also be associated with pneumonia. To determine the relation of graft-versus-host disease with pneumonia, we evaluated the autopsies of 59 allogeneic and two autologous recipients and 74 control patients with various pulmonary diseases, who had not received a bone-marrow transplant. Lymphocytic bronchitis, characterized by lymphocyte-associated necrosis of the bronchial mucosa and often the submucosal glands, was present in 12 of 20 patients with Grade 2 or greater graft-versus-host disease but in only three of 39 with Grade 0 to 1 disease (P less than 0.0005). Onset of respiratory disease correlated with the time of onset of graft-versus-host disease. Patients with lymphocytic bronchitis had a higher incidence of bronchopneumonia and acute bronchitis of the lower respiratory tract. Lymphocytic bronchitis did not occur in the controls and appears to be a component of graft-versus-host disease that leads to bronchopneumonia, probably through destruction of the mucociliary apparatus.

Non-Infectious Bronchiolitis as an Early Pulmonary Complication of Hematopoietic Stem Cell Transplantation

“…1B) (8), which is in agreement with the report of Yousem (9) and that using a rat model (12). On the other hand, some have suggested that lymphocytic bronchitis is unrelated to GVHD, using canine models (13).…”

Non-infectious lung complications are closely associated with chronic graft-versus-host disease: a single center study of incidence, risk factors and outcome

“…Whereas most authors seem to agree about the important role of chronic GVHD in the pathogenesis of bronchiolitis obliterans and lymphocytic interstitial pneumonitis, [7][8][9]15,[24][25][26] the relationship between chronic GVHD and lymphocytic bronchitis remains unclear. 17,18 From a pathophysiological point of view the very low incidence of NILC in the group of patients receiving autologous stem cells provides convincing indirect evidence for the involvement of alloreactive T cells in the pathogenesis of NILC. Only one patient out of 25 (4%) autologous patients developed a NILC compared with 40 out of 272 allogeneic patients (14.7%).…”

“…7,14 In contrast, the role of chronic GVHD in the development of lymphocytic interstitial pneumonitis or bronchitis has not been settled. [15][16][17][18][19] In two recent series of 29 and 18 patients, chronic GVHD was identified as a potent risk factor for late-onset pulmonary syndromes. 13,14 The authors assume that alloreactivity may be the underlying mechanism of lung disease in these cases.…”

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

“…Lung involvement by aGVHD is a highly controversial issue. Early works describing this entity [1,2] were later under discussion by other authors [3,4,5]. Animal models recently helped to understand this entity, and some authors consider donor T lymphocytes as one of the sources of lung damage after allogeneic hematopoietic transplantation.…”

“…Some authors have considered lymphocytic bronchitis to be the pulmonary manifestation of acute graft versus host disease (aGVHD) [1]. However, a pulmonary interstitial syndrome with interstitial and peribronchial lymphocytic infiltrate with very good response to steroid treatment resembling aGVHD was later described [2].…”