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

Abstract

Summary:Non-infectious lung complications (NILC) are frequent, influencing morbidity and mortality of patients after allogeneic BMT. Although the term NILC encompasses a number of different entities, an association with GVHD has been noted for almost all of them. Our study was directed towards assessing the incidence and risk factors for developing NILC, as well as the response to treatment and long-term outcome. Forty (14.7%) out of 272 patients surviving for more than 3 months after allogeneic BMT, developed lung complications fulfilling the criteria for NILC. The evaluation was based on clinical investigation, radiologic imaging, lung function tests, broncho-alveolar lavage and biopsies. Risk factors were assessed by univariate and multiple statistical regression models, where chronic GVHD proved to be the only significant risk factor for the development of NILC (P = 0.011). In three patients NILC developed in direct association with donor lymphocyte infusions. The majority of patients responded well to treatment with corticosteroids and immunosuppressive drugs. NILC had no adverse effect on survival. The frequency of NILC was low in autologous (5%) as compared with allogeneic transplants (14.7%) but this difference was not statistically significant. Bone Marrow Transplantation (2000) 25, 1263-1268.

Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation

“…The latter limitation adds to the call made by others to improve routine data collection in BMT patients for use in future investigations. 14 In summary, in a large group of patients who received BMT, we observed that approximately 6% had a major decrease in the FEV1/FVC ratio consistent with the onset of OB. Patients with OB almost universally had predating cGVHD and had greater mortality.…”

Morphologic changes leading to bronchiolitis obliterans in a patient with delayed non-infectious lung disease after allogeneic bone marrow transplantation

“…[1][2][3][4][5] We recently proposed a clinicopathologic categorization of DLD as subacute cellular interstitial pneumonia, bronchiolitis obliterans and acute lung injury. We also demonstrated these entities to be heterogeneous in regard to variables such as predominant pattern of lung involvement (airway or parenchyma), onset and clinical behaviour (acute, subacute, or chronic) and response to immunosuppressive treatment.…”

“…5,6 The pathogenesis is still a matter of debate, although a key role for immunopathologic mechanisms related to chronic graft-versus-host disease (c-GVHD) has been strongly suggested by the identification of c-GVHD in sites other than the lung as a risk factor and by the satisfactory response to the immunosuppressive therapy observed in several previous studies. [1][2][3][4][5] However, a temporally unified view of the ongoing morphologic reactions taking place in this setting remains an enigma to us since no longitudinal biopsy results have been available until now.…”

Late-onset non-infectious pulmonary complications following allogeneic hematopoietic stem cell transplantation in children

“…8,9 The incidence of LONIPCs is 10-25% and they are closely associated with TRM. 8,10,11 The pathogenesis of LONIPCs has not been elucidated, but their development is consistently associated with the presence of chronic GVHD, [10][11][12][13][14][15][16] indicating that allo-immune reactions play a major role in the development of LONIPCs.…”