Late‐onset noninfectious pulmonary complications after allogeneic bone marrow transplantation

Abstract

We examined the incidence and clinical outcome of late‐onset noninfectious pulmonary complications (LONIPC) in a series of 234 patients who underwent allogeneic bone marrow transplantation at our institution between April 1982 and October 1996. The 179 patients who survived 3 months or more were evaluated. Clinical, radiologic, pulmonary function, and pathologic tests were reviewed to identify 18 patients (10%) who fulfilled the diagnostic criteria of LONIPC. Accordingly, the pulmonary processes included bronchiolitis obliterans (BO, five patients), bronchiolitis obliterans with organizing pneumonia (BOOP, three patients), diffuse alveolar damage (DAD, one patient), lymphocytic interstitial pneumonia (LIP, one patient), and nonclassifiable interstitial pneumonia (NCIP, eight patients). Various methods of enhanced immunosuppressive therapy resulted in marked durable remission in nine patients (50%) (3/3 with BOOP, 3/8 with NCIP, 1/1 with DAD, 1/1 with LIP, 1/5 with BO). The presence of chronic graft‐versus‐host disease (cGVHD) and prophylaxis for GVHD with cyclosporine and prednisone were the only variables significantly associated with the development of LONIPC (P = 0.0001 and 0.008, respectively). Regardless of histology, a reduction in the forced expiratory volume to < 45% of the predicted range was associated with poor response to treatment. These findings suggest a strong association between cGVHD and LONIPC and that the risk of LONIPC development may be influenced by the particular method of GVHD prophylaxis. Most patients with BOOP or mild airflow limitation at diagnosis achieved durable remissions.

Pre-transplant risk factors for cryptogenic organizing pneumonia/bronchiolitis obliterans organizing pneumonia after hematopoietic cell transplantation

“…28 COP/BOOP has been reported to respond to steroid treatment. [8][9][10][11][12] However, it frequently recurs and repeatedly deteriorates. 2,3,5,9 Taking the fact into consideration, COP/BOOP might affect survivals in a later phase of allogeneic HCT rather than that in an early phase.…”

“…2,3,[5][6][7] The incidence of COP/ BOOP after HCT has been reported to range from 1 to 10%, and it appears at a median of 100 days or later after HCT. 2,3 Although COP/BOOP has been reported to respond to steroid treatment, [8][9][10][11][12] recurrence is often observed and prolonged steroid treatment is frequently required. 2,3,5,9 COP/BOOP occasionally progresses to thoracic air-leak syndrome and can be refractory to treatment.…”

“…Almost all of the previous studies were limited to case reports or series that did not include more than 10 cases of COP/BOOP, and/ or did not analyze COP/BOOP independently but rather as a part of late-onset non-infectious pulmonary complications. 6,7,[10][11][12][14][15][16][17] To the best of our knowledge, only one report, from Seattle, has included more than 20 cases (49 cases with COP/BOOP). 8 Thus, we performed a large retrospective study that included about 200 patients with COP/BOOP.…”

Outcome and treatment of late-onset noninfectious pulmonary complications after allogeneic haematopoietic SCT

“…8,9 After the first case report of fatal bronchiolitis in an allo-HSCT recipient with chronic GVHD (cGVHD) in 1982, 10 a series of LONIPCs were described in 1987 as smallairway disease in recipients of allo-HSCT. 11 In 1998, Palmas et al 12 classified LONIPCs after allo-HSCT into five groups: bronchiolitis obliterans (BO), bronchiolitis obliterans with organizing pneumonia (BOOP), diffuse alveolar damage, lymphocytic interstitial pneumonia and nonclassifiable pneumonia. According to this classification, BO was diagnosed based on the obstructive pattern in pulmonary function tests (PFTs) and the other LONIPCs on histological findings.…”

“…According to this classification, BO was diagnosed based on the obstructive pattern in pulmonary function tests (PFTs) and the other LONIPCs on histological findings. 12 It is thus impractical to apply this classification to clinical settings because this criterion relies heavily on histology and lung specimens are not always available. These facts limited the standardization of Palmas's criteria and individual reports of LONIPCs use different classification criteria.…”