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

• Published in: Annals of hematology Vol. 98; no. 9; pp. 2187 - 2195
• Main Authors: Brownback, Kyle R., Frey, John W., Abhyankar, Sunil
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2019; Springer Nature B.V
• Subjects: Adult; Aged; Bronchoalveolar Lavage Fluid; Eosinophilia - diagnostic imaging; Eosinophilia - drug therapy; Eosinophilia - physiopathology; Eosinophils; Female; Graft vs Host Disease - diagnostic imaging; Graft vs Host Disease - drug therapy; Graft vs Host Disease - physiopathology; Hematology; Hematopoietic Stem Cell Transplantation; Humans; Lung - diagnostic imaging; Lung - physiopathology; Male; Medicine; Medicine & Public Health; Middle Aged; Neutrophils; Oncology; Original; Original Article; Pneumonia; Pneumonia - diagnostic imaging; Pneumonia - drug therapy; Pneumonia - etiology; Pneumonia - physiopathology; Respiratory Function Tests; Stem cell transplantation; Stem cells; Tomography, X-Ray Computed; Transplants & implants; Organizing pneumonia; Bronchiolitis obliterans; Pulmonary infiltrate; Stem cell transplant
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s00277-019-03746-3

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.