A chronic pulmonary syndrome associated with graft-versus-host disease after allogeneic marrow transplantation

Transplantation. 1992 Dec;54(6):1002-8. doi: 10.1097/00007890-199212000-00012.

Abstract

Of 143 consecutive patients who survived at least 6 months after bone marrow transplantation (allogeneic [n = 131]; syngeneic [n = 5]; or autologous [n = 7]) and whose pulmonary function was evaluated before and on at least 2 occasions after BMT, 29 (20%) developed a chronic pulmonary syndrome without evidence for an infectious etiology. Twenty-eight (97%) presented with cough and 22 (76%) with dyspnea; abnormal chest signs were crackles in 23 (79%) and wheeze in 22 (76%). Chest roentgenogram showed pulmonary infiltrates in 15 (52%) cases but was normal in 14 (48%). All patients had major reductions in lung volumes (forced expiratory volume in 1 sec [FEV1]; relaxed vital capacity [VC]; and alveolar volume [VA]), and/or diffusing capacity (pulmonary diffusing capacity [TLCO] and single-breath carbon monoxide coefficient [KCO]). The obstructive component varied with only 18 (62%) patients developing overt airways obstruction (FEV1/VC < 75%), and in 6 of this group the fall in lung volumes preceded the onset of airways obstruction. Open lung biopsy (n = 4) showed both bronchiolitis obliterans and chronic patchy interstitial pneumonitis. The development of this syndrome was associated with acute (P < 0.001) and chronic (P < 0.0001) graft-versus-host disease of other organ systems. Twenty-four (83%) patients had a partial or complete response to immunosuppressive agents. Six (21%) have died, five (17%) of pulmonary complications. We suggest that this syndrome may be a manifestation of chronic GVHD involvement of the lung.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Airway Obstruction / complications
  • Airway Obstruction / diagnostic imaging
  • Airway Obstruction / microbiology
  • Biopsy
  • Bone Marrow Transplantation / adverse effects*
  • Child
  • Chronic Disease
  • Female
  • Graft vs Host Disease / complications*
  • Graft vs Host Disease / etiology*
  • Humans
  • Lung / pathology
  • Lung Diseases / complications*
  • Lung Diseases / epidemiology
  • Lung Diseases / physiopathology
  • Male
  • Middle Aged
  • Pulmonary Fibrosis / complications
  • Pulmonary Fibrosis / diagnostic imaging
  • Pulmonary Fibrosis / microbiology
  • Radiography
  • Respiratory Function Tests
  • Risk Factors
  • Syndrome
  • Transplantation, Homologous