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Shanthikumar S, Gower WA, Cooke KR, Bergeron A, Schultz KR, Barochia A, Tamae-Kakazu M, Charbek E, Reardon EE, Calvo C, Casey A, Cheng PC, Cole TS, Davies SM, Das S, De A, Deterding RR, Liptzin DR, Mechinaud F, Rayment JH, Robinson PD, Siddaiah R, Stone A, Srinivasin S, Towe CT, Yanik GA, Iyer NP, Goldfarb SB. Diagnosis of Post-Hematopoietic Stem Cell Transplantation Bronchiolitis Obliterans Syndrome in Children: Time for a Rethink? Transplant Cell Ther 2024:S2666-6367(24)00411-1. [PMID: 38897861 DOI: 10.1016/j.jtct.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/28/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
Hematopoietic stem cell transplantation (HSCT) is undertaken in children with the aim of curing a range of malignant and nonmalignant conditions. Unfortunately, pulmonary complications, especially bronchiolitis obliterans syndrome (BOS), are significant sources of morbidity and mortality post-HSCT. Currently, criteria developed by a National Institutes of Health (NIH) working group are used to diagnose BOS in children post-HSCT. Unfortunately, during the development of a recent American Thoracic Society (ATS) Clinical Practice Guideline on this topic, it became apparent that the NIH criteria have significant limitations in the pediatric population, leading to late diagnosis of BOS. Specific limitations include use of an outdated pulmonary function testing reference equation, a reliance on spirometry, use of a fixed forced expiratory volume in 1 second (FEV1) threshold, focus on obstructive defects defined by FEV1/vital capacity, and failure to acknowledge that BOS and infection can coexist. In this review, we summarize the evidence regarding the limitations of the current criteria. We also suggest potential evidence-based ideas for improving these criteria. Finally, we highlight a new proposed criteria for post-HSCT BOS in children that were developed by the authors of the recently published ATS clinical practice guideline, along with a pathway forward for improving timely diagnosis of BOS in children post-HSCT.
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Affiliation(s)
- Shivanthan Shanthikumar
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia; Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - William A Gower
- Division of Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kenneth R Cooke
- Department of Oncology, Pediatric Blood and Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Anne Bergeron
- Pneumology Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Kirk R Schultz
- Pediatric Hematology/Oncology/BMT, BC Children's Research Institute/UBC, Vancouver, British Columbia, Canada
| | - Amisha Barochia
- Laboratory of Asthma and Lung Inflammation, Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Maximiliano Tamae-Kakazu
- Division of Pulmonary and Critical Care, Corewell Health, Grand Rapids, Michigan; Department of Medicine, Michigan State University College of Human Medicine, Michigan
| | - Edward Charbek
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri
| | - Erin E Reardon
- Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia
| | - Charlotte Calvo
- Pediatric Hematology and Immunology Department, Robert Debré Hospital, Paris Cité University, Paris, France; Human Immunology, Pathophysiology and Immunotherapy, INSERM UMR-976, Institut de Recherche Saint-Louis, Paris, France
| | - Alicia Casey
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pi Chun Cheng
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Theresa S Cole
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia; Infection & immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Stella M Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shailendra Das
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Alive De
- Division of Pediatric Pulmonology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Robin R Deterding
- Chief Pediatric Pulmonary and Sleep Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Deborah R Liptzin
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Francoise Mechinaud
- Pediatric Hematology and Immunology Department, Robert Debré Hospital, Paris Cité University, Paris, France
| | - Jonathan H Rayment
- Division of Respiratory Medicine, BC Children's Hospital, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Paul D Robinson
- Department of Respiratory Medicine, Queensland Children's Hospital, Queensland, Australia; Children's Health and Environment Program, Child Health Research Centre, University of Queensland, Queensland, Australia; Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, New South Wales, Australia
| | - Roopa Siddaiah
- Division of Pulmonology, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Anne Stone
- Division of Pediatric Pulmonology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Saumini Srinivasin
- Department of Pediatrics, University of Tennessee College of Medicine, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Christopher T Towe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Gregory A Yanik
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan
| | - Narayan P Iyer
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Samuel B Goldfarb
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Division of Pulmonary Medicine, Masonic Children's Hospital, Minneapolis, Minnesota
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Cortes-Santiago N, Patel KR, Wu H, Sartain SE, Bhar S, Silva-Carmona M, Pogoriler J. Pulmonary Histopathologic Findings in Pediatric Patients After Hematopoietic Stem Cell Transplantation: An Autopsy Study. Pediatr Dev Pathol 2023; 26:362-373. [PMID: 37165556 DOI: 10.1177/10935266231170101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Pathologic characterization of pulmonary complications following hematopoietic stem cell transplantation (HSCT) is limited. We describe lung findings in pediatric patients who died following HSCT and attempt to identify potential clinical associations. METHODS Pathology databases at Texas Children's Hospital and the Children's Hospital of Philadelphia were queried (2013-2018 CHOP and 2017-2018 TCH). Electronic medical records and slides were reviewed. RESULTS Among 29 patients, 19 received HSCT for hematologic malignancy, 8 for non-malignant hematologic disorders, and 2 for metastatic solid tumors. Twenty-five patients (86%) showed 1 or more patterns of acute and organizing lung injury. Sixty-two percent had microvascular sclerosis, with venous involvement noted in most cases and not correlating with clinical history of pulmonary hypertension, clinical transplant-associated thrombotic microangiopathy, irradiation, or graft-versus-host disease. Features suggestive of graft-versus-host-disease were uncommon: 6 patients had lymphocytic bronchiolitis, and only 2 patients had evidence of bronchiolitis obliterans (both clinically unexpected), both with a mismatched unrelated donor transplant. CONCLUSIONS Acute and subacute alveolar injury (diffuse alveolar damage or organizing pneumonia) is common in pediatric patients who died following HSCT and is difficult to assign to a specific etiology. Microvascular sclerosis was frequent and did not correlate with a single distinct clinical feature.
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Affiliation(s)
- Nahir Cortes-Santiago
- Department of Pathology and Immunology, Texas Children's Hospital, Houston, TX, USA
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Kalyani R Patel
- Department of Pathology and Immunology, Texas Children's Hospital, Houston, TX, USA
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Hao Wu
- Department of Pathology, Yale School of Medicine and Yale New Haven Hospital, New Haven, CT, USA
| | - Sarah E Sartain
- Department of Pediatrics, Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Saleh Bhar
- Department of Pediatrics, Section of Hematology/Oncology and Critical Care Medicine, Bone Marrow Transplantation, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Manuel Silva-Carmona
- Department of Pediatrics, Section of Pulmonology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Pogoriler
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Baba K, Matsubara Y, Hirata Y, Ota Y, Takahashi S, Boku N. Case report: Irinotecan-induced interstitial lung disease in an advanced colorectal cancer patient resurfacing decades after allogeneic bone marrow transplantation for aplastic anemia; a case report and narrative review of literature. Front Oncol 2023; 13:1215789. [PMID: 37397386 PMCID: PMC10313190 DOI: 10.3389/fonc.2023.1215789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Two mechanisms of drug-induced interstitial lung disease (DILD) have been reported: 1) direct injury of lung epithelial cells and/or endothelial cells in lung capillaries by the drug and/or its metabolites and 2) hypersensitivity reactions. In both mechanisms, immune reactions such as cytokine and T cell activation are involved in DILD. While past and present lung diseases and accumulative lung damage due to smoking and radiation are risk factors for DILD, the association between the immune status of the host and DILD is not well known. Herein, we report a case of advanced colorectal cancer with a history of allogeneic bone marrow transplantation for aplastic anemia more than 30 years prior, in which DILD occurred early after irinotecan-containing chemotherapy. Bone marrow transplantation might be a potential risk factor for DILD.
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Affiliation(s)
- Keisuke Baba
- Department of Oncology and General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasuo Matsubara
- Department of Oncology and General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Hirata
- Department of Oncology and General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasunori Ota
- Department of Diagnostic Pathology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoshi Takahashi
- Department of Hematology/Oncology, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Narikazu Boku
- Department of Oncology and General Medicine, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Pleuroparenchymal Fibroelastosis: A Review with a Focus on a Non-Infectious Complications after Hematopoietic Stem Cell Transplant. Biomedicines 2023; 11:biomedicines11030924. [PMID: 36979903 PMCID: PMC10046474 DOI: 10.3390/biomedicines11030924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a rare disease that is currently classified as an idiopathic interstitial pneumonia. Although originally described as an idiopathic disease, PPFE has now been identified as a rare complication following hematopoietic stem cell transplant (HSCT). Unlike other pulmonary complications after HSCT, PPFE occurs very late after transplant. Etiologies for PPFE after HSCT remain to be fully established. Infections and adverse effects to alkylating chemotherapy have been suggested as possible causes. In several cases, there is an association of PPFE with bronchiolitis obliterans syndrome after HSCT, suggesting that PPFE may be another manifestation of pulmonary chronic graft versus host disease after HSCT. Algorithms have been designed to assist in confirming a diagnosis of PPFE without the need for a surgical lung biopsy, however at present, no biomarker is established for the diagnosis or to predict the progression of disease. Presently, there is no current therapy for PPFE, but fortunately the disease progresses slowly in most patients.
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Brugière O, Bergeron A, Le Pavec J. [Lung transplantation for chronic graft-versus-host disease after hematopoietic stem cell transplantation]. Rev Mal Respir 2023; 40 Suppl 1:e69-e72. [PMID: 36682955 DOI: 10.1016/j.rmr.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- O Brugière
- Service de pneumologie, hôpital Foch, Suresnes, France.
| | - A Bergeron
- Hôpitaux universitaires de Genève, Genève, Suisse; Université de Paris, UMR 1153 CRESS, biostatistics and clinical epidemiology research team, Paris, France
| | - J Le Pavec
- Service de pneumologie et transplantation pulmonaire, groupe hospitalier Marie-Lannelongue -Saint Joseph, Le Plessis-Robinson, France; Université Paris-Saclay, Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Sud, Inserm, groupe hospitalier Marie-Lannelongue -Saint Joseph, Le Plessis-Robinson, France
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6
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Interstitial lung diseases after hematopoietic stem cell transplantation: New pattern of lung chronic graft-versus-host disease? Bone Marrow Transplant 2023; 58:87-93. [PMID: 36309588 PMCID: PMC9812763 DOI: 10.1038/s41409-022-01859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 01/10/2023]
Abstract
Bronchiolitis obliterans syndrome (BOS) after allogeneic HSCT is the only formally recognized manifestation of lung chronic graft-versus-host disease (GVHD). Other lung complications were reported, including interstitial lung diseases (ILDs). Whether ILDs belong to the spectrum of lung cGVHD remains unknown. We compared characteristics and specific risk factors for both ILD and BOS. Data collected from consecutive patients diagnosed with ILD or BOS from 1981-2019 were analyzed. The strength of the association between patient characteristics and ILD occurrence was measured via odds ratios estimated from univariable logistic models. Multivariable models allowed us to handle potential confounding variables. Overall survival (OS) was estimated using the Kaplan-Meier method. 238 patients were included: 79 with ILD and 159 with BOS. At diagnosis, FEV1 was lower in patients with BOS compared to patients with ILD, while DLCO was lower in ILD. 84% of ILD patients received systemic corticosteroids, leading to improved CT scans and pulmonary function, whereas most BOS patients were treated by inhaled corticosteroids, with lung-function stabilization. In the multivariable analysis, prior thoracic irradiation and absence of prior treatment with prednisone were associated with ILD. OS was similar, even if hematological relapse was more frequent in the ILD group. Both complications occurred mainly in patients with GVHD history.
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Graft-versus-host disease may cause pulmonary restriction, but not all restriction is graft-versus-host disease. Blood Adv 2022; 6:4984-4986. [PMID: 35793452 PMCID: PMC9631650 DOI: 10.1182/bloodadvances.2022008201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/16/2022] [Indexed: 11/20/2022] Open
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Glanville AR, Benden C, Bergeron A, Cheng GS, Gottlieb J, Lease ED, Perch M, Todd JL, Williams KM, Verleden GM. Bronchiolitis obliterans syndrome after lung or haematopoietic stem cell transplantation: current management and future directions. ERJ Open Res 2022; 8:00185-2022. [PMID: 35898810 PMCID: PMC9309343 DOI: 10.1183/23120541.00185-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/18/2022] [Indexed: 11/05/2022] Open
Abstract
Bronchiolitis obliterans syndrome (BOS) may develop after either lung or haematopoietic stem cell transplantation (HSCT), with similarities in histopathological features and clinical manifestations. However, there are differences in the contributory factors and clinical trajectories between the two conditions. BOS after HSCT occurs due to systemic graft-versus-host-disease (GVHD), whereas BOS after lung transplantation is limited to the lung allograft. BOS diagnosis after HSCT is more challenging, as the lung function decline may occur due to extrapulmonary GVHD, causing sclerosis or inflammation in the fascia or muscles of the respiratory girdle. Treatment is generally empirical with no established effective therapies. This review provides rare insights and commonalities of both conditions, that are not well elaborated elsewhere in contemporary literature, and highlights the importance of cross disciplinary learning from experts in other transplant modalities. Treatment algorithms for each condition are presented, based on the published literature and consensus clinical opinion. Immunosuppression should be optimised, and other conditions or contributory factors treated where possible. When initial treatment fails, the ultimate therapeutic option is lung transplantation (or re-transplantation in the case of BOS after lung transplantation) in carefully selected candidates. Novel therapies under investigation include aerosolised liposomal cyclosporine, Janus kinase inhibitors, antifibrotic therapies, and (in patients with BOS after lung transplantation) B-cell–directed therapies. Effective novel treatments that have a tangible impact on survival and thereby avoid the need for lung transplantation or re-transplantation are urgently required.
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Alam W, Mohamad R, Koubaissi M, Koubaissi SA. Fibrotic Cystic Lung Disease Post Hematopoietic Stem Cell Transplant: Who is the Culprit? CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221097317. [PMID: 35591973 PMCID: PMC9112311 DOI: 10.1177/11795476221097317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/07/2022] [Indexed: 11/16/2022]
Abstract
Pulmonary complications post hematopoietic stem cell transplant (HSCT) are associated with poor outcomes and require extensive management depending on the etiology. They usually present in the form of bronchiolitis obliterans syndrome, interstitial pneumonitis, or drug toxicity that can lead to fibrosis. Scant data exists regarding diffuse cystic lung disease following HSCT, and the existing literature only mentions mild cystic changes. We present the case of a 25-year-old man with stage IVB Hodgkin's lymphoma post allogeneic HSCT, who developed progressive traction bronchiectasis, with the appearance of extensive pulmonary cysts that followed significant fibrotic changes and discuss the possible etiologies behind it.
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Affiliation(s)
- Walid Alam
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Mohamad
- Pulmonary and Critical Care Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maysoun Koubaissi
- Department of Internal Medicine, Lebanese University, Beirut, Lebanon
| | - Salwa A Koubaissi
- Pulmonary and Critical Care Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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The ISHLT Chronic Lung Allograft Dysfunction Consensus Criteria is Applicable to Pulmonary Chronic Graft-versus-Host Disease. Blood Adv 2022; 6:4196-4207. [PMID: 35522969 PMCID: PMC9327555 DOI: 10.1182/bloodadvances.2021006885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
Abstract
Pulmonary chronic graft-versus-host disease (PcGvHD) is a devastating complication of allogeneic hematopoietic stem cell transplant (HCT). The 2014 NIH chronic GvHD (cGvHD) Consensus Criteria (NIH Criteria) only captures bronchiolitis obliterans syndrome (BOS). In this study, we adapted the 2019 Criteria of chronic lung allograft dysfunction (CLAD) to define novel phenotypes of PcGvHD and compared the performance of this criteria with the NIH Criteria to identify high-risk PcGvHD patients. We reviewed consecutive patients in a cGvHD natural history protocol (NCT00092235) and adapted the 2019 CLAD Criteria (the Adapted Criteria) to define PcGvHD as post-HCT FEV1 <80% predicted value, with four phenotypes: obstructive, restrictive, mixed obstructive/restrictive and undefined. An independent adjudication committee evaluated subjects for diagnosis and phenotyping. We identified 166 (47.4%) patients who met the Adapted Criteria, including obstructive (n = 12, 3.4%), restrictive (n=67, 19.1%), mixed obstruction/restriction (n = 47, 13.4%) and undefined (n = 40, 11.4%). In these patients, less than half (n= 78) met the NIH criteria for BOS (NIH+), the rest (n=88) did not (NIH-). The NIH- subjects showed increased risk of death compared to those without PcGvHD (HR = 1.88, 95%CI = 1.20-2.95, p = 0.006) that was similar to NIH+ subjects (p = 0.678). Our study demonstrated the potential of the Adapted Criteria in identifying high risk PcGvHD patients that have been missed by the NIH Criteria. The Adapted Criteria could become a valuable tool to better phenotype and study lung disease in cGvHD.
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Pulmonary graft-versus-host disease and chronic lung allograft dysfunction: two sides of the same coin? THE LANCET RESPIRATORY MEDICINE 2022; 10:796-810. [DOI: 10.1016/s2213-2600(22)00001-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022]
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Abstract
INTRODUCTION Hematologic malignancies are cancers of the blood, bone marrow and lymph nodes and represent a heterogenous group of diseases that affect people of all ages. Treatment generally involves chemotherapeutic or targeted agents that aim to kill malignant cells. In some cases, hematopoietic stem cell transplantation (HCT) is required to replenish the killed blood and stem cells. Both disease and therapies are associated with pulmonary complications. As survivors live longer with the disease and are treated with novel agents that may result in secondary immunodeficiency, airway diseases and respiratory infections will increasingly be encountered. To prevent airways diseases from adding to the morbidity of survivors or leading to long-term mortality, improved understanding of the pathogenesis and treatment of viral bronchiolitis, BOS, and bronchiectasis is necessary. AREAS COVERED This review focuses on viral bronchitis, BOS and bronchiectasis in people with hematological malignancy. Literature was reviewed from Pubmed for the areas covered. EXPERT OPINION Airway disease impacts significantly on hematologic malignancies. Viral bronchiolitis, BOS and bronchiectasis are common respiratory manifestations in hematological malignancy. Strategies to identify patients early in their disease course may improve the efficacy of treatment and halt progression of lung function decline and improve quality of life.
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Affiliation(s)
- Ricardo J. José
- Department of Respiratory Medicine, Host Defence, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW36NP, United Kingdom,Centre for Inflammation and Tissue Repair, UCL Respiratory, 5 University Street, London, WC1E6JF, United Kingdom
| | - Burton F. Dickey
- Department of Pulmonary Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, United States of America
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, United States of America
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Kreft A, Alverson C, Wagner-Drouet EM, Ries I, Sommer C, Dr.re.nat MS. Veno-occlusive Disease of the Lung After Allogeneic Haematopoietic Stem-cell Transplantation: An Autopsy Study. Pathol Res Pract 2022; 231:153799. [DOI: 10.1016/j.prp.2022.153799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022]
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Beyond Bronchiolitis Obliterans: In-Depth Histopathologic Characterization of Bronchiolitis Obliterans Syndrome after Lung Transplantation. J Clin Med 2021; 11:jcm11010111. [PMID: 35011851 PMCID: PMC8745215 DOI: 10.3390/jcm11010111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/31/2022] Open
Abstract
Bronchiolitis obliterans syndrome (BOS) is considered an airway-centered disease, with bronchiolitis obliterans (BO) as pathologic hallmark. However, the histologic spectrum of pure clinical BOS remains poorly characterized. We provide the first in-depth histopathologic description of well-characterized BOS patients and patients without chronic lung allograft dysfunction (CLAD), defined according to the recent consensus guidelines. Explant lung tissue from 52 clinically-defined BOS and 26 non-CLAD patients (collected 1993-2018) was analyzed for histologic parameters, including but not limited to airway lesions, vasculopathy and fibrosis. In BOS, BO lesions were evident in 38 (73%) patients and varied from concentric sub-epithelial fibrotic BO to inflammatory BO, while 10/14 patients without BO displayed 'vanishing airways', defined by a discordance between arteries and airways. Chronic vascular abnormalities were detected in 22 (42%) patients. Ashcroft fibrosis scores revealed a median of 43% (IQR: 23-69) of normal lung parenchyma per patient; 26% (IQR: 18-37) of minimal alveolar fibrous thickening; and 11% (IQR: 4-18) of moderate alveolar thickening without architectural damage. Patchy areas of definite fibrotic damage to the lung structure (i.e., Ashcroft score ≥5) were present in 28 (54%) patients. Fibrosis was classified as bronchocentric (n = 21/28, 75%), paraseptal (n = 17/28, 61%) and subpleural (n = 15/28, 54%). In non-CLAD patients, BO lesions were absent, chronic vascular abnormalities present in 1 (4%) patient and mean Ashcroft scores were significantly lower compared to BOS (p = 0.0038) with 78% (IQR: 64-88) normally preserved lung parenchyma. BOS explant lungs revealed evidence of various histopathologic findings, including vasculopathy and fibrotic changes, which may contribute to the pathophysiology of BOS.
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Ikegami N, Nakajima N, Yoshizawa A, Handa T, Chen-Yoshikawa T, Kubo T, Tanizawa K, Ohsumi A, Yamada Y, Hamaji M, Nakajima D, Yutaka Y, Tanaka S, Watanabe K, Nakatsuka Y, Murase Y, Nakanishi T, Niwamoto T, Chin K, Date H, Hirai T. Clinical, radiological, and pathological features of idiopathic and secondary interstitial pneumonia cases with pleuroparenchymal fibroelastosis undergoing lung transplantation. Histopathology 2021; 80:665-676. [PMID: 34747513 DOI: 10.1111/his.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/27/2021] [Accepted: 11/06/2021] [Indexed: 11/28/2022]
Abstract
AIMS Idiopathic pleuroparenchymal fibroelastosis (PPFE) is a rare type of idiopathic interstitial pneumonia, and pathological PPFE is also observed in secondary interstitial pneumonia. This study aimed to evaluate the pathological findings associated with radiological PPFE-like lesions and the clinical and morphological features of patients with pathological PPFE. METHODS AND RESULTS We retrospectively reviewed the pathology of the explanted lungs from 59 lung transplant recipients with radiological PPFE-like lesions. Pathological PPFE lesions were identified in 14 patients with idiopathic cases and 12 patients with secondary cases. Pathological PPFE was associated with previous pneumothorax, a volume loss in the upper lobes and a flattened chest. Patients with idiopathic and secondary cases with pathological PPFE had similar clinical, radiological, and pathological findings, while fibroblastic foci were more common in patients with idiopathic cases, and patients with secondary cases more frequently showed alveolar septal thickening with elastosis or fibrosis. Post-transplantation survival did not differ between patients with idiopathic and secondary cases with pathological PPFE (log-rank; P=0.57) and was similar between patients with idiopathic cases with pathological PPFE and patients with idiopathic pulmonary fibrosis (IPF) (log-rank; P = 0.62). CONCLUSIONS Not all patients with interstitial pneumonia with radiological PPFE-like lesions have pathological PPFE. Characteristic clinical features can suggest the presence of pathological PPFE, and idiopathic and secondary cases with pathological PPFE are similar except for fibroblastic foci in idiopathic cases and alveolar septal thickening with elastosis or fibrosis in secondary cases. Patients with pathological PPFE have a similar prognosis to those with IPF after transplantation.
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Affiliation(s)
- Naoya Ikegami
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Nakajima
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyofumi Chen-Yoshikawa
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Thoracic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Radiology, Tenri Hospital, Tenri, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satona Tanaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kizuku Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Respiratory Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yoshinari Nakatsuka
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuko Murase
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoko Nakanishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takafumi Niwamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Astashchanka A, Ryan J, Lin E, Nokes B, Jamieson C, Kligerman S, Malhotra A, Mandel J, Joshua J. Pulmonary Complications in Hematopoietic Stem Cell Transplant Recipients-A Clinician Primer. J Clin Med 2021; 10:3227. [PMID: 34362012 PMCID: PMC8348211 DOI: 10.3390/jcm10153227] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
Hematopoietic stem cell transplants (HSCT) are becoming more widespread as a result of optimization of conditioning regimens and prevention of short-term complications with prophylactic antibiotics and antifungals. However, pulmonary complications post-HSCT remain a leading cause of morbidity and mortality and are a challenge to clinicians in both diagnosis and treatment. This comprehensive review provides a primer for non-pulmonary healthcare providers, synthesizing the current evidence behind common infectious and non-infectious post-transplant pulmonary complications based on time (peri-engraftment, early post-transplantation, and late post-transplantation). Utilizing the combination of timing of presentation, clinical symptoms, histopathology, and radiographic findings should increase rates of early diagnosis, treatment, and prognostication of these severe illness states.
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Affiliation(s)
- Anna Astashchanka
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA 92121, USA; (A.A.); (E.L.); (B.N.); (A.M.); (J.M.)
| | - Joseph Ryan
- Division of Hematology & Oncology, Scripps Clinic, La Jolla, CA 92037, USA;
| | - Erica Lin
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA 92121, USA; (A.A.); (E.L.); (B.N.); (A.M.); (J.M.)
| | - Brandon Nokes
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA 92121, USA; (A.A.); (E.L.); (B.N.); (A.M.); (J.M.)
| | - Catriona Jamieson
- Sanford Stem Cell Clinical Center, Moores Cancer Center, Department of Medicine, Division of Regenerative Medicine, University of California San Diego, La Jolla, CA 92093, USA;
| | - Seth Kligerman
- Division of Cardiothoracic Radiology, University of California San Diego, La Jolla, CA 92121, USA;
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA 92121, USA; (A.A.); (E.L.); (B.N.); (A.M.); (J.M.)
| | - Jess Mandel
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA 92121, USA; (A.A.); (E.L.); (B.N.); (A.M.); (J.M.)
| | - Jisha Joshua
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA 92121, USA; (A.A.); (E.L.); (B.N.); (A.M.); (J.M.)
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17
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National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. The 2020 Highly morbid forms report. Transplant Cell Ther 2021; 27:817-835. [PMID: 34217703 DOI: 10.1016/j.jtct.2021.06.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 12/12/2022]
Abstract
Chronic graft-versus-host disease (GVHD) can be associated with significant morbidity, in part because of nonreversible fibrosis, which impacts physical functioning (eye, skin, lung manifestations) and mortality (lung, gastrointestinal manifestations). Progress in preventing severe morbidity and mortality associated with chronic GVHD is limited by a complex and incompletely understood disease biology and a lack of prognostic biomarkers. Likewise, treatment advances for highly morbid manifestations remain hindered by the absence of effective organ-specific approaches targeting "irreversible" fibrotic sequelae and difficulties in conducting clinical trials in a heterogeneous disease with small patient numbers. The purpose of this document is to identify current gaps, to outline a roadmap of research goals for highly morbid forms of chronic GVHD including advanced skin sclerosis, fasciitis, lung, ocular and gastrointestinal involvement, and to propose strategies for effective trial design. The working group made the following recommendations: (1) Phenotype chronic GVHD clinically and biologically in future cohorts, to describe the incidence, prognostic factors, mechanisms of organ damage, and clinical evolution of highly morbid conditions including long-term effects in children; (2) Conduct longitudinal multicenter studies with common definitions and research sample collections; (3) Develop new approaches for early identification and treatment of highly morbid forms of chronic GVHD, especially biologically targeted treatments, with a special focus on fibrotic changes; and (4) Establish primary endpoints for clinical trials addressing each highly morbid manifestation in relationship to the time point of intervention (early versus late). Alternative endpoints, such as lack of progression and improvement in physical functioning or quality of life, may be suitable for clinical trials in patients with highly morbid manifestations. Finally, new approaches for objective response assessment and exploration of novel trial designs for small populations are required.
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18
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Verleden SE, Von der Thüsen J, Roux A, Brouwers ES, Braubach P, Kuehnel M, Laenger F, Jonigk D. When tissue is the issue: A histological review of chronic lung allograft dysfunction. Am J Transplant 2020; 20:2644-2651. [PMID: 32185874 DOI: 10.1111/ajt.15864] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 01/25/2023]
Abstract
Although chronic lung allograft dysfunction (CLAD) remains the major life-limiting factor following lung transplantation, much of its pathophysiology remains unknown. The discovery that CLAD can manifest both clinically and morphologically in vastly different ways led to the definition of distinct subtypes of CLAD. In this review, recent advances in our understanding of the pathophysiological mechanisms of the different phenotypes of CLAD will be discussed with a particular focus on tissue-based and molecular studies. An overview of the current knowledge on the mechanisms of the airway-centered bronchiolitis obliterans syndrome, as well as the airway and alveolar injuries in the restrictive allograft syndrome and also the vascular compartment in chronic antibody-mediated rejection is provided. Specific attention is also given to morphological and molecular markers for early CLAD diagnosis or histological changes associated with subsequent CLAD development. Evidence for a possible overlap between different forms of CLAD is presented and discussed. In the end, "tissue remains the (main) issue," as we are still limited in our knowledge about the actual triggers and specific mechanisms of all late forms of posttransplant graft failure, a shortcoming that needs to be addressed in order to further improve the outcome of lung transplant recipients.
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Affiliation(s)
- Stijn E Verleden
- Lab of Respiratory Diseases, BREATH, Department of CHROMETA, KU Leuven, Leuven, Belgium.,Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany
| | - Jan Von der Thüsen
- Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Antoine Roux
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Emily S Brouwers
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Peter Braubach
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Mark Kuehnel
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Florian Laenger
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), The German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hannover Medical School (MHH), Hannover, Germany
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19
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Naidoo J, Nishino M, Patel SP, Shankar B, Rekhtman N, Illei P, Camus P. Immune-Related Pneumonitis After Chemoradiotherapy and Subsequent Immune Checkpoint Blockade in Unresectable Stage III Non-Small-Cell Lung Cancer. Clin Lung Cancer 2020; 21:e435-e444. [PMID: 32576443 DOI: 10.1016/j.cllc.2020.02.025] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/06/2020] [Accepted: 02/29/2020] [Indexed: 12/28/2022]
Abstract
Approximately one third of patients with non-small-cell lung cancer (NSCLC) present with stage III or locally advanced NSCLC. These patients have historically been managed with chemoradiotherapy. However, outcomes for these patients remain poor, with a 5-year survival rate between 15% and 32%. Immune checkpoint inhibitors have revolutionized the treatment of patients with NSCLC. One such agent, durvalumab, a selective high-affinity human immunoglobulin G1 monoclonal antibody that blocks programmed cell death ligand 1 binding to programmed cell death protein 1 and cluster of differentiation 80, was recently approved in the consolidation setting after completion of definitive platinum-based chemoradiotherapy and has become the current standard of care for patients with stage III locally advanced NSCLC. Immune checkpoint blockade is associated with increased risk of immunotherapy-related adverse events, which can be managed most effectively when detected early, ideally in the context of a multidisciplinary approach. Pneumonitis represents the potentially most severe and life-threatening of all reported immunotherapy-related adverse events, but it is further complicated in the context of recent prior therapies also known to cause pulmonary toxicity, such as radiotherapy. However, there are major gaps in our ability to identify immunotherapy-related pneumonitis and distinguish it from radiation pneumonitis. This review aims to define the key steps in the detection, diagnosis, and treatment of immunotherapy-related pneumonitis.
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Affiliation(s)
- Jarushka Naidoo
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, MD, USA.
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandip Pravin Patel
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Bairavi Shankar
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Illei
- Department of Pathology and Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Phillipe Camus
- Department of Pulmonary Medicine and Critical Care, Centre Hospitalier et Université de Bourgogne, Dijon, France
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20
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Sergi CM. Lower Respiratory Tract. PATHOLOGY OF CHILDHOOD AND ADOLESCENCE 2020:139-253. [DOI: 10.1007/978-3-662-59169-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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21
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Bondeelle L, Gras J, Michonneau D, Houdouin V, Hermet E, Blin N, Nicolini F, Michallet M, Dominique S, Huynh A, Leroy S, Socié G, Thabut G, Reynaud-Gaubert M, Tazi A, Bergeron A. Pleuroparenchymal fibroelastosis after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2019; 55:982-986. [PMID: 31413312 DOI: 10.1038/s41409-019-0636-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/16/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Louise Bondeelle
- Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Saint-Louis, Service de Pneumologie, F-75010, Paris, France
| | - Julien Gras
- Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Saint-Louis, Service de Pneumologie, F-75010, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Saint-Louis, Service de Maladies infectieuses, F-75010, Paris, France
| | - David Michonneau
- Univ Paris Diderot, Sorbonne Paris Cité AP-HP, Hôpital Saint-Louis, Service d'Hématologie-Greffe, F-75010, Paris, France
| | - Véronique Houdouin
- Univ Paris Diderot, Sorbonne Paris Cité AP-HP, Hôpital Robert Debré, Service de Pédiatrie, F-75010, Paris, France
| | - Eric Hermet
- Service de thérapie cellulaire et d'hématologie clinique adulte, Université d'Auvergne EA3846, CIC-501, CHU Clermont-Ferrand Hôpital Estaing, Clermont-Ferrand, France
| | - Nicolas Blin
- Service d'Hématologie, CHU Nantes, Nantes, France
| | | | | | - Stéphane Dominique
- Service de Pneumologie, CHU Caen, Avenue Côte de Nacre, 14000, Caen, France
| | - Anne Huynh
- Secteur de greffe, CHU-Oncopole, Toulouse, France
| | - Sylvie Leroy
- Univ Côte d'Azur, CHU Nice, Department of Pulmonary Medicine, FHU OncoAge, Nice, France
| | - Gérard Socié
- Univ Paris Diderot, Sorbonne Paris Cité AP-HP, Hôpital Saint-Louis, Service d'Hématologie-Greffe, F-75010, Paris, France
| | - Gabriel Thabut
- Univ Paris Diderot, Sorbonne Paris Cité, Service de Pneumologie, Transplantation pulmonaire, Hôpital Bichat, 46 Rue Henri Huchard, 75877, Paris, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie, maladies respiratoires rares, mucoviscidose; CHU de Marseille - Hôpital Nord, Chemin des Bourrely, 13915, Marseille, Cedex 20, France
| | - Abdellatif Tazi
- Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Saint-Louis, Service de Pneumologie, F-75010, Paris, France.,UMR 1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, F-75010, Paris, France
| | - Anne Bergeron
- Univ Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Saint-Louis, Service de Pneumologie, F-75010, Paris, France. .,UMR 1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, F-75010, Paris, France.
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22
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Phenotypical diversity of airway morphology in chronic lung graft vs. host disease after stem cell transplantation. Mod Pathol 2019; 32:817-829. [PMID: 30723292 DOI: 10.1038/s41379-019-0203-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023]
Abstract
Pulmonary graft vs. host disease is a diverse and underestimated complication following allogenic hematopoietic stem cell transplantation. We aimed to compare the airway architecture with chronic lung allograft dysfunction post lung transplantation. Inflated explant lungs from graft vs. host disease patients were compared with lungs with chronic lung allograft dysfunction following lung transplantation, and control lungs using a combination of CT, microCT, and histology (n = 6 per group) and pathology in the (small) airways was further quantified and analyzed. Following allogenic hematopoietic stem cell transplantation, three patients presented as bronchiolitis obliterans syndrome and three patients showed interstitial changes and restriction. The CT analysis demonstrated a strong similarity between bronchiolitis obliterans syndrome after lung transplantation and post allogenic hematopoietic stem cell transplantation, evidenced by severe ( > 50%) airway obstruction from generation 9, with 70.8% of the airways ending in obstruction. Further analysis indicated that the airways either collapsed or accumulated matrix along a segment of the airway. In patients with restriction and interstitial changes following allogenic hematopoietic stem cell transplantation, the degree of airway obstruction was lower compared with bronchiolitis obliterans syndrome post allogenic hematopoietic stem cell transplantation, but similar to restrictive allograft syndrome post lung transplantation, showing a lower proportion of airway obstruction (20-35%), decreased number of terminal bronchioles per lung (p < 0.01), and parenchymal fibrosis. We observed similarities in the airway and parenchymal morphometric changes in lung graft vs. host disease and with chronic lung allograft dysfunction following lung transplantation, suggesting similar pathophysiological mechanisms.
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23
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Bondeelle L, Bergeron A. Managing pulmonary complications in allogeneic hematopoietic stem cell transplantation. Expert Rev Respir Med 2018; 13:105-119. [PMID: 30523731 DOI: 10.1080/17476348.2019.1557049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Progress in allogeneic hematopoietic stem cell transplantation (HSCT) procedures has been associated with improved survival in HSCT recipients. However, they have also brought to light organ-specific complications, especially pulmonary complications. In this setting, pulmonary complications are consistently associated with poor outcomes, and improved management of these complications is required. Areas covered: We review the multiple infectious and noninfectious lung complications that occur both early and late after allogeneic HSCT. This includes the description of these complications, risk factors, diagnostic approach and outcome. A literature search was performed using PubMed-indexed journals. Expert commentary: Multiple lung complications after allogeneic HSCT can be diagnosed concomitantly and require a multidisciplinary approach. A specific clinical evaluation including a precise analysis of a lung CT scan is necessary. Management of these lung complications, especially the noninfectious ones, is impaired by the lack of prospective, randomized control trials, suggesting preventive strategies should be developed.
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Affiliation(s)
- Louise Bondeelle
- a Université Paris Diderot, Service de Pneumologie , APHP, Hôpital Saint-Louis , Paris , France
| | - Anne Bergeron
- a Université Paris Diderot, Service de Pneumologie , APHP, Hôpital Saint-Louis , Paris , France.,b Biostatistics and Clinical Epidemiology Research Team , Univ Paris Diderot, Sorbonne Paris Cité, UMR 1153 CRESS , Paris , France
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