Association between acute and chronic graft-versus-host disease and bronchiolitis obliterans organizing pneumonia in recipients of hematopoietic stem cell transplants

• Published in: Blood Vol. 102; no. 10; pp. 3822 - 3828
• Main Authors: Freudenberger, Todd D., Madtes, David K., Curtis, J. Randall, Cummings, Peter, Storer, Barry E., Hackman, Robert C.
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 15.11.2003; The Americain Society of Hematology
• Subjects: Acute Disease; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Case-Control Studies; Chronic Disease; Chronic obstructive pulmonary disease, asthma; Cryptogenic Organizing Pneumonia - etiology; Cryptogenic Organizing Pneumonia - pathology; Female; Graft vs Host Disease - complications; Graft vs Host Disease - pathology; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Intestinal Diseases - complications; Intestinal Diseases - etiology; Male; Medical sciences; Mouth Diseases - complications; Mouth Diseases - etiology; Odds Ratio; Pneumology; Retrospective Studies; Risk Factors; Skin Diseases - complications; Skin Diseases - etiology; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Human; Immunopathology; Respiratory disease; Acute; Stem cell; Hematopoietic cell; Homograft; Graft versus host reaction; Chronic; Bronchiolitis obliterans organizing pneumonia; Bronchus disease; Graft; Complication; Bronchiolitis obliterans
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2002-06-1813

Bronchiolitis obliterans organizing pneumonia (BOOP) has been reported following hematopoietic stem cell (HSC) transplantation, but the clinical features and risk factors for this disorder have not been well characterized. This case-control study of 49 patients with histologic BOOP and 161 control subjects matched by age and year of transplantation describes the clinical features and analyzes the risk factors for BOOP following HSC transplantation. Data on clinical features and outcome were collected by chart review. Odds ratios, estimating the relative risk of BOOP in allogeneic HSC recipients, were calculated by conditional logistic regression with adjustment for potential confounding factors. Clinical features of BOOP in this population were similar to idiopathic BOOP and BOOP occurring in other disease settings. There was an association between acute and chronic graft-versus-host disease (GVHD) and the subsequent development of BOOP (odds ratios, 3.8 [95% CI, 1.2 to 12.3] and 3.1 [95% CI, 1.1 to 9.2], respectively). Patients with BOOP were more likely to have acute GVHD involving the skin (odds ratio, 4.6; P = .005) and chronic GVHD involving the gut (odds ratio, 6.6; P = .018) and oral cavity (odds ratio, 5.9; P = .026). This study shows that histologic BOOP following HSC transplantation has clinical features that resemble idiopathic BOOP and is strongly associated with prior acute and chronic GVHD. These results have important implications for the care of patients who develop respiratory symptoms after HSC transplantation and may help elucidate the pathogenesis of idiopathic BOOP. (Blood. 2003;102:3822-3828)