Non‐specific interstitial pneumonia as a manifestation of graft‐versus‐host disease following pediatric allogeneic hematopoietic stem cell transplantation

Abstract

Bronchiolitis obliterans (BO) is generally believed to be a marker of pulmonary manifestation of graft-versus-host disease (GVHD) in patients who have undergone bone marrow transplantation for hematological malignancy. Pulmonary manifestations reported as GVHD (other than BO) include lymphocytic bronchiolitis with cellular interstitial pneumonia, lymphoid interstitial pneumonia, veno-occlusive disease, and diffuse alveolar damage. Morphological reactions in the lungs of bone marrow transplant recipients associated with interstitial pneumonia have not been described systematically. Reported herein is a fibrosing non-specific interstitial pneumonia (NSIP) pattern together with BO in both lungs in an 8-year-old girl following a second allogeneic hematopoietic stem cell transplantation for relapsed neuroblastoma of adrenal origin. The course was complicated by bilateral pneumothoraces, and the patient underwent lung transplantation 3 years after the second stem cell transplantation. Because the patient had chronic GVHD of the skin and the liver preceeded by the development of pulmonary involvement, NSIP may represent one of the facets of pulmonary GVHD.

Pleuroparenchymal fibroelastosis and non‐specific interstitial pneumonia: frequent pulmonary sequelae of haematopoietic stem cell transplantation

“…The NSIP pattern was present in 15 patients (75%): nine had fibrotic NSIP (Figure E) and six had cellular NSIP. NSIP was mostly focal, with two patients having diffuse involvement throughout the lung, as reported previously . Foci of the NSIP pattern were present in all lung lobes, with a predominance in the lower lobe.…”

“…Pulmonary manifestations reported as cGVHD include constrictive bronchiolitis obliterans (CBO), lymphocytic bronchiolitis (LB), and veno‐occlusive disease (VOD) . Recently, histological changes resembling pleuroparenchymal fibroelastosis (PPFE) or non‐specific interstitial pneumonia (NSIP) have been described in lungs of HSCT recipients. Idiopathic PPFE was established as a new entity in the 2013 American Thoracic Society/European Respiratory Society Idiopathic Interstitial Pneumonia statement .…”

Hematopoietic Stem Cell Transplantation

“…140 Unfortunately, some of the clinical literature remains confounded by use of confusing terminology, including the older "bronchiolitis obliterans organizing pneumonia (BOOP)." 144 The so-called eosinophilic pulmonary syndrome has been rarely reported in HCT patients, and is thought to be pathophysiologically distinct from eosinophilic pneumonias in non-HCT settings (Loeffler's, allergic bronchopulmonary aspergillosis, and hypereosinophilic syndrome, etc.). 144 The so-called eosinophilic pulmonary syndrome has been rarely reported in HCT patients, and is thought to be pathophysiologically distinct from eosinophilic pneumonias in non-HCT settings (Loeffler's, allergic bronchopulmonary aspergillosis, and hypereosinophilic syndrome, etc.).…”

Stem cells in clinical practice: applications and warnings

“…Since the occurrence of OB has been closely associated with GVHD, it has been hypothesized that OB is mediated, partially, by alloimmunologic injury to host bronchiolar epithelial cells [81-83]. Usually, OB develops as a late complication, i.e.…”