Nodular pulmonary lesions in children after autologous stem cell transplantation: a source of misinterpretation

Fazekas, Tamás; Wiesbauer, P.; Kronberger, Martina; Wank, H.; Gadner, Helmut; Dworzak, Michael

doi:10.1111/j.1365-2141.2007.06951.x

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…COP is exceedingly rare in children [12] and seen mainly after hematopoietic stem cell transplantation (HSCT) [2,13]. In the case described here, COP was noted BCDT with RTX for presumed PTLD, 4 years prior to the detection of multifocal (stage 4) cHL-type PTLD.…”

Section: Discussionmentioning

confidence: 75%

Cryptogenic organizing pneumonia after rituximab therapy for presumed post-kidney transplant lymphoproliferative disease

et al. 2010

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Cryptogenic organizing pneumonia (COP, formerly bronchiolitis obliterans organizing pneumonia) is rare in children. We describe an 11-year-old girl with Epstein-Barr virus (EBV) reactivation/presumed post-transplant lymphoproliferative disease (PTLD) 15 months after undergoing a deceased donor kidney transplantation. Treatment with reduced immunosuppression, ganciclovir, and cytomegalovirus immunoglobulin was complicated by severe graft rejection, prompting therapy with methylprednisolone, anti-thymocyte globulin and four weekly doses of rituximab (total 1500 mg/m(2)). Tacrolimus- and prednisone-based anti-rejection prophylaxis was complemented with low-dose sirolimus. When the lactate dehydrogenase and uric acid levels rose 10 weeks after the first rituximab infusion and bilateral pulmonary nodules were detected by computerized tomography, recurrence of PTLD was suspected. Open lung biopsy of the clinically asymptomatic patient identified the nodules as COP, characterized by abundant CD3(+) T-cells, few B-cells, and the absence of EBV, cytomegalovirus, or adenovirus antigens. With normalization of the peripheral B-cell count, EB viremia reappeared and persisted, despite minimal immunosuppression. Four years later, the patient was diagnosed with classical Hodgkin lymphoma-type PTLD with multiple pulmonary and abdominal nodes. This first report of rituximab-associated, pediatric COP highlights the risk of pulmonary complications after treatment with B-cell depleting agents in solid organ transplant recipients, and the importance of a histopathologic diagnosis and vigilant follow-up of such lesions.

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Section: Discussionmentioning

confidence: 75%

Cryptogenic organizing pneumonia after rituximab therapy for presumed post-kidney transplant lymphoproliferative disease

et al. 2010

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“…Though rare, BOOP has been described in children after autologous HSCT. Therefore, an alloimmunologic reaction may not be the only mechanism involved [108]. Regardless of the precipitating insult, it appears that BOOP is secondary to alveolar epithelial injury [109,110].…”

Section: Boopmentioning

confidence: 99%

Non-infectious pulmonary complications of hematopoietic stem cell transplantation

Rowan

Baloğlu

McArthur

2015

J Pediatr Intensive Care

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Noninfectious pulmonary complications of hematopoietic stem cell transplant are currently more prevalent than infectious complications. Unfortunately, the pathophysiology basis is not completely understood. However, there is a string association with graft-versus-host disease for many of them. Therefore, an important component of their pathophysiology is likely an allo-immune response. There is much research that needs to be conducted to improve the less than optimal outcomes for these disorders.

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Autologous hematopoietic stem cell transplantation following high-dose chemotherapy for non-rhabdomyosarcoma soft tissue sarcomas

Peinemann¹,

Smith²,

Kromp³

et al. 2011

Cochrane Database of Systematic Reviews

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Nodular pulmonary lesions in children after autologous stem cell transplantation: a source of misinterpretation

Cited by 4 publications

References 15 publications

Cryptogenic organizing pneumonia after rituximab therapy for presumed post-kidney transplant lymphoproliferative disease

Cryptogenic organizing pneumonia after rituximab therapy for presumed post-kidney transplant lymphoproliferative disease

Non-infectious pulmonary complications of hematopoietic stem cell transplantation

Autologous hematopoietic stem cell transplantation following high-dose chemotherapy for non-rhabdomyosarcoma soft tissue sarcomas

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