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Bronchoscopic features, associations, and outcomes of organizing pneumonia following allogeneic hematopoietic stem cell transplantation

  • Kyle R. BrownbackEmail author
  • John W. Frey
  • Sunil Abhyankar
Original Article
  • 33 Downloads

Abstract

Organizing pneumonia (OP) is a poorly understood complication of hematopoietic stem cell transplant (HSCT). We identified 15 patients diagnosed with OP following HSCT and described their clinical course. CT chest findings were remarkable for multifocal infiltrates that were predominantly consolidating or ground glass opacities. Bronchoalveolar lavage (BAL) was performed on 14 patients with five having lymphocytosis (> 25% lymphocytes), three with eosinophilia (> 5% eosinophils), three with neutrophilia (> 30% neutrophils), and three with normal cell counts. Flow cytometry was analyzed on BAL fluid in 13 patients with 11 having a CD4/CD8 of < 0.9. Initial treatment with 0.3–1.0 mg/kg prednisone resulted in improvement in symptoms, in radiographic findings, and in pulmonary function testing for the majority of patients. Six patients had recurrence of OP after completing treatment. Eleven patients had evidence of extra-pulmonary graft-versus-host disease prior to diagnosis of OP, and seven patients were diagnosed with an upper respiratory tract infection (URI) within 8 weeks of OP diagnosis. Most patients respond well to prednisone with significant improvement in pulmonary function, but risk of recurrence is high after cessation of steroid treatment. Risk factors for the development of OP may include prior URI.

Keywords

Organizing pneumonia Stem cell transplant Bronchiolitis obliterans Pulmonary infiltrate 

Notes

Compliance with ethical standards

Local institutional review board gave approval for this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineUniversity of Kansas School of MedicineKansas CityUSA
  2. 2.Division of Pulmonary and Critical Care MedicineUniversity of Kansas Medical CenterKansas CityUSA
  3. 3.Department of Internal MedicineUniversity of Kansas School of MedicineKansas CityUSA
  4. 4.Division of Hematologic Malignancies and Cellular TherapeuticsUniversity of Kansas School of MedicineKansas CityUSA

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