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Post-Transplant Complications

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

Abstract

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.

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References

  1. Krowka MJ, Rosenow EC, Hoagland HC . Pulmonary complications of bone marrow transplantation Chest 1985 87: 237–246

    Article  CAS  Google Scholar 

  2. Weiner RS, Bortin MM, Gale RP et al. Interstitial pneumonitis after bone marrow transplantation: assessment of risk factors Ann Intern Med 1986 104: 168–173

    Article  CAS  Google Scholar 

  3. Quabeck K . The lung as a critical organ in marrow transplantation Bone Marrow Transplant 1994 14: (Suppl. 49) 519–528

    Google Scholar 

  4. Soubani AO, Miller KB, Hassoun PM . Pulmonary complications of bone marrow transplantation Chest 1996 109: 1066–1077

    Article  CAS  Google Scholar 

  5. Neiman P, Wasserman PB, Wentworth BB . Interstitial pneumonia and cytomegalovirus infection a complication of human marrow transplantation Transplantation 1973 15: 478–485

    Article  CAS  Google Scholar 

  6. Clark JG, Hansen JA, Hertz MI et al. Idiopathic pneumonia syndrome after bone marrow transplantation. NHLBI workshop summary Am Rev Resp Dis 1993 147: 1601–1606

    Article  CAS  Google Scholar 

  7. Ralph DD, Springmeyer SC, Sullivan KM et al. Rapidly progressive air-flow-obstruction in marrow transplant recipients: possible association between obliterative bronchiolitis and chronic-graft-versus-host disease Am Rev Resp Dis 1984 129: 641–644

    CAS  PubMed  Google Scholar 

  8. Wyatt SE, Nunn P, Hows JM . Airways obstruction associated with graft-versus-host disease after bone marrow transplantation Thorax 1984 39: 887–894

    Article  CAS  Google Scholar 

  9. Holland HK, Wingard JR, Beschorner WE et al. Bronchiolitis obliterans in bone marrow transplantation and its relationship to chronic-graft-versus-host disease and low serum IgG Blood 1988 72: 621–628

    CAS  PubMed  Google Scholar 

  10. Robins RA, Linder J, Stahl MG . Diffuse alveolar hemmorrhage in autologous bone marrow transplant recipients Am J Med 1989 87: 511–518

    Article  Google Scholar 

  11. Wojno KJ, Vogelsang GB, Beschorner WE, Santos GW . Pulmonary hemorrhage as a cause of death in allogeneic bone marrow recipients with severe acute graft-verus-host disease Transplantation 1994 57: 88–92

    Article  CAS  Google Scholar 

  12. Janin-Mercier A, Valade S, Boccon-Gibbod L et al. Pulmonary lesions following bone marrow graft. Study of 35 cases Ann Pathol 1985 5: 183–194

    CAS  PubMed  Google Scholar 

  13. Schwarer AP, Hughes JM, Trotman-Dickinson B et al. A chronic pulmonary syndrome associated with graft-versus-host disease after allogeneic bone marrow transplantation Transplantation 1992 54: 1002–1008

    Article  CAS  Google Scholar 

  14. Palmas A, Tefferi A, Myers JL et al. Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation Br J Haematol 1998 100: 680–687

    Article  CAS  Google Scholar 

  15. Perrault C, Cousineau S, D'Angelo G et al. Lymphoid interstitial pneumonia after allogeneic bone marrow transplantation Cancer 1985 55: 1–9

    Article  Google Scholar 

  16. Bunjes D, Heit W, Arnold R et al. Cyclosporine as an alternative to cyclophosphamide in the treatment of chronic GvHD Transplantation 1986 41: 170–172

    Article  CAS  Google Scholar 

  17. Beschorner WE, Saral R, Hutchins GM et al. Lymphocytic bronchitis associated with graft-versus-host disease in recipients of bone-marrow transplants New Engl J Med 1978 299: 1030–1036

    Article  CAS  Google Scholar 

  18. O'Brien KD, Hackman RS, Sale GE et al. Lymphocytic bronchitis unrelated to acute graft-versus-host disease in canine marrow graft recipients Transplantation 1984 37: 233–238

    Article  CAS  Google Scholar 

  19. Curtis DJ, Smale A, Thien F et al. Chronic airflow obstruction in long-term survivors of allogeneic bone marrow transplantation Bone Marrow Transplant 1995 16: 169–173

    CAS  PubMed  Google Scholar 

  20. Bunjes D, Hertenstein B, Wiesneth M et al. In vivo/ex vivo T cell depletion reduces the morbidity of allogeneic bone marrow transplantation in patients with acute leukemias in first remission without increasing the risk of treatment failure: comparison with cyclopsporine/methotrexate Bone Marrow Transplant 1995 15: 563–568

    CAS  PubMed  Google Scholar 

  21. Stokes ME, Davis CS, Koch GG . Categorical Data Analysis Using the SAS System SAS Institute: Cary, NC 1995

    Google Scholar 

  22. Neter J, Wasserman W, Kutner MH . Applied Linear Statistic Models: Regression, Analysis of Variance, and Experimental Designs Richard D Irwin: Homewood 1985

    Google Scholar 

  23. Roca J, Granena A, Rodriguez RR et al. Fatal airway disease in an adult with chronic graft-versus-host disease Thorax 1982 37: 77–78

    Article  CAS  Google Scholar 

  24. Ostrow D, Buskard N, Hill RS et al. Bronchiolitis obliterans complicating bone marrow transplantation Chest 1985 87: 828–830

    Article  CAS  Google Scholar 

  25. Clark JG, Schwartz DA, Flournoy N et al. Risk factors for airflow obstruction in recipients of bone marrow transplants Ann Intern Med 1987 107: 648–656

    Article  CAS  Google Scholar 

  26. Clark JG, Crawford SW, Madtes DK, Sullivan KM . Obstructive lung disease after allogeneic marrow transplantation. Clinical presentation and course Ann Intern Med 1989 111: 368–376

    Article  CAS  Google Scholar 

  27. Cooke KR, Kobzik L, Martin TR et al. An experimental model of idiopathic pneumonia syndrome after bone marrow transplanation: I. The roles of minor H antigens and endotoxin Blood 1996 8: 3230–3239

    Google Scholar 

  28. Milburn HJ, Du Bois R, Prentice HG, Poulter LW . Pneumonitis in bone marrow transplantation results from a local immune response Clin Exp Immunol 1990 81: 232–237

    Article  CAS  Google Scholar 

  29. Milburn HJ, Prentice HG, Poulter LW . Abnormal alveolar macrophage populations in bone marrow transplant recipients with pneumonitis Eur Respir J 1993 6: 1295–1300

    CAS  PubMed  Google Scholar 

  30. Bowden RA, Mori M, Dobbs S et al. Mononuclear cell reconstitution in the lung after marrow transplantation Transplantation 1993 55: 557–561

    Article  CAS  Google Scholar 

  31. Leblond V, Zouabi H, Sutton L et al. Late CD8+ lymphocytic alveolitis after allogeneic bone marrow transplantation and chronic graft-versus-host disease Am J Resp Crit Care Med 1994 150: 1056–1061

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Dr Markus Hoegel, Birgit Hay and Margit Hafner for performing the statistic calculations.

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Duncker, C., Dohr, D., von Harsdorf, S. et al. Non-infectious lung complications are closely associated with chronic graft-versus-host disease: a single center study of incidence, risk factors and outcome. Bone Marrow Transplant 25, 1263–1268 (2000). https://doi.org/10.1038/sj.bmt.1702429

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