Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation

Angelo Palmas, Ayalew Tefferi, Jeffrey L. Myers, John P. Scott, Stephen J. Swensen, Michael G. Chen, Dennis A. Gastineau, Morie Gertz, David J. Inwards, Martha Lacy, Mark R Litzow

Research output: Contribution to journalArticle

172 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)680-687
Number of pages8
JournalBritish Journal of Haematology
Volume100
Issue number4
DOIs
StatePublished - 1998

Fingerprint

Homologous Transplantation
Bone Marrow Transplantation
Lung
Cryptogenic Organizing Pneumonia
Interstitial Lung Diseases
Graft vs Host Disease
Bronchiolitis Obliterans
Respiratory Function Tests
Forced Expiratory Volume
Immunosuppressive Agents
Prednisone
Cyclosporine
Histology
Incidence

Keywords

  • Allogeneic bone marrow transplantation
  • Bronchiolitis obliterans
  • Bronchiolitis obliterans with organizing pneumonia
  • Noninfectious
  • Pulmonary complications

ASJC Scopus subject areas

  • Hematology

Cite this

Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation. / Palmas, Angelo; Tefferi, Ayalew; Myers, Jeffrey L.; Scott, John P.; Swensen, Stephen J.; Chen, Michael G.; Gastineau, Dennis A.; Gertz, Morie; Inwards, David J.; Lacy, Martha; Litzow, Mark R.

In: British Journal of Haematology, Vol. 100, No. 4, 1998, p. 680-687.

Research output: Contribution to journalArticle

Palmas, Angelo ; Tefferi, Ayalew ; Myers, Jeffrey L. ; Scott, John P. ; Swensen, Stephen J. ; Chen, Michael G. ; Gastineau, Dennis A. ; Gertz, Morie ; Inwards, David J. ; Lacy, Martha ; Litzow, Mark R. / Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation. In: British Journal of Haematology. 1998 ; Vol. 100, No. 4. pp. 680-687.
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AU - Palmas, Angelo

AU - Tefferi, Ayalew

AU - Myers, Jeffrey L.

AU - Scott, John P.

AU - Swensen, Stephen J.

AU - Chen, Michael G.

AU - Gastineau, Dennis A.

AU - Gertz, Morie

AU - Inwards, David J.

AU - Lacy, Martha

AU - Litzow, Mark R

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KW - Bronchiolitis obliterans with organizing pneumonia

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KW - Pulmonary complications

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