Bronchoscopic features, associations, and outcomes of organizing pneumonia following allogeneic hematopoietic stem cell transplantation
- 33 Downloads
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.
KeywordsOrganizing pneumonia Stem cell transplant Bronchiolitis obliterans Pulmonary infiltrate
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.
- 2.Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, Martin P, Chien J, Przepiorka D, Couriel D, Cowen EW, Dinndorf P, Farrell A, Hartzman R, Henslee-Downey J, Jacobsohn D, McDonald G, Mittleman B, Rizzo JD, Robinson M, Schubert M, Schultz K, Shulman H, Turner M, Vogelsang G, Flowers MED (2005) National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. diagnosis and staging working group report. Biol Blood Marrow Transplant 11(12):945–956CrossRefGoogle Scholar
- 4.Bhatia S, Francisco L, Carter A, Sun CL, Baker KS, Gurney JG, McGlave PB, Nademanee A, O'Donnell M, Ramsay NKC, Robison LL, Snyder D, Stein A, Forman SJ, Weisdorf DJ (2007) Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the bone marrow transplant survivor study. Blood 110(10):3784–3792CrossRefGoogle Scholar
- 16.Yoshihara S, Yanik G, Cooke KR, Mineishi S (2007) Bronchiolitis obliterans syndrome (BOS), bronchiolitis obliterans organizing pneumonia (BOOP), and other late-onset noninfectious pulmonary complications following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 13(7):749–759CrossRefGoogle Scholar
- 17.Nakasone H, Onizuka M, Suzuki N, Fujii N, Taniguchi S, Kakihana K, Ogawa H, Miyamura K, Eto T, Sakamaki H, Yabe H, Morishima Y, Kato K, Suzuki R, Fukuda T (2013) Pre-transplant risk factors for cryptogenic organizing pneumonia/bronchiolitis obliterans organizing pneumonia after hematopoietic cell transplantation. Bone Marrow Transplant 48(10):1317–1323CrossRefGoogle Scholar
- 18.Ditschkowski M, Elmaagacli AH, Trenschel R, Peceny R, Koldehoff M, Schulte C, Beelen DW (2007) T-cell depletion prevents from bronchiolitis obliterans and bronchiolitis obliterans with organizing pneumonia after allogeneic hematopoietic stem cell transplantation with related donors. Haematologica 92(4):558–561CrossRefGoogle Scholar
- 21.Costabel U, Teschler H, Guzman J (1992) Bronchiolitis obliterans organizing pneumonia (BOOP): the cytological and immunocytological profile of bronchoalveolar lavage. Eur Respir J 5(7):791–797Google Scholar
- 25.Bradley B, Branley HM, Egan JJ, Greaves MS, Hansell DM, Harrison NK et al (2008) Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and new Zealand and the Irish thoracic society. Thorax 63(Suppl 5):v1–v58Google Scholar
- 26.Cheng GS, Stednick ZJ, Madtes DK, Boeckh M, McDonald GB, Pergam SA (2016) Decline in the use of surgical biopsy for diagnosis of pulmonary disease in hematopoietic cell transplantation recipients in an era of improved diagnostics and empirical therapy. Biol Blood Marrow Transplant 22(12):2243–2249CrossRefGoogle Scholar
- 28.Davison AG, Heard BE, McAllister WA, Turner-Warwick ME (1983) Cryptogenic organizing pneumonitis. Q J Med 52(207):382–394Google Scholar
- 33.Kim SJ, Lee JW, Jung CW, Min CK, Cho B, Shin HJ, Chung JS, Kim H, Lee WS, Joo YD, Yang DH, Kook H, Kang HJ, Ahn HS, Yoon SS, Sohn SK, Min YH, Min WS, Park HS, Won JH (2010) Weekly rituximab followed by monthly rituximab treatment for steroid-refractory chronic graft-versus-host disease: results from a prospective, multicenter, phase II study. Haematologica 95(11):1935–1942CrossRefGoogle Scholar
- 34.Pierelli L, Perseghin P, Marchetti M, Messina C, Perotti C, Mazzoni A, Bacigalupo A, Locatelli F, Carlier P, Bosi A, Società Italiana di Emaferesi and Manipolazione Cellulare (SIdEM), Gruppo Italiano Trapianto Midollo Osseo (GITMO) (2013) Extracorporeal photopheresis for the treatment of acute and chronic graft-versus-host disease in adults and children: best practice recommendations from an Italian Society of Hemapheresis and Cell Manipulation (SIdEM) and Italian Group for Bone Marrow Transplantation (GITMO) consensus process. Transfusion 53(10):2340–2352Google Scholar
- 35.Zeiser R, Burchert A, Lengerke C, Verbeek M, Maas-Bauer K, Metzelder SK, Spoerl S, Ditschkowski M, Ecsedi M, Sockel K, Ayuk F, Ajib S, de Fontbrune FS, Na IK, Penter L, Holtick U, Wolf D, Schuler E, Meyer E, Apostolova P, Bertz H, Marks R, Lübbert M, Wäsch R, Scheid C, Stölzel F, Ordemann R, Bug G, Kobbe G, Negrin R, Brune M, Spyridonidis A, Schmitt-Gräff A, van der Velden W, Huls G, Mielke S, Grigoleit GU, Kuball J, Flynn R, Ihorst G, du J, Blazar BR, Arnold R, Kröger N, Passweg J, Halter J, Socié G, Beelen D, Peschel C, Neubauer A, Finke J, Duyster J, von Bubnoff N (2015) Ruxolitinib in corticosteroid-refractory graft-versus-host disease after allogeneic stem cell transplantation: a multicenter survey. Leukemia 29(10):2062–2068CrossRefGoogle Scholar