Skip to main content
SpringerLink
Log in

Noninfectious Pulmonary Manifestation of GVHD: Bronchiolitis Obliterans Syndrome

  • Chapter
  • First Online:
Pathology of Graft vs. Host Disease

  • 712 Accesses

Abstract

Pulmonary manifestations of GVHD encompass a spectrum of histologic lesions associated with both acute GVHD (aGVHD) and chronic GVHD (cGVHD). These include cryptogenic organizing pneumonia (COP), multifactorial lymphocytic bronchiolitis (LLB), and constrictive bronchiolitis obliterans (CBO). Workup of patients suspected of pulmonary cGVHD should include radiologic studies such as CT, pulmonary function tests, and bronchoalveolar lavage to rule out potential infectious agents. Lung biopsy to diagnose constrictive bronchiolitis obliterans is indicated when no other sites of involvement by cGVHD are discovered. Here we present a patient with complex pathology post-HSCT with histologic features in a lung biopsy of cryptogenic organizing pneumonia (formerly termed bronchiolitis organizing pneumonia (BOOP)) and necropsy changes of acute bronchopneumonia admixed with features of both organizing pneumonia and constrictive bronchiolitis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Shulman HM, Cardona DM, Greenson JK, et al. NIH consensus development project on criteria for clinical trials in chronic graft-versus-host disease: II. The 2014 pathology working group report. Biol Blood Marrow Transplant. 2015;21(4):589–603.

    Article  Google Scholar 

  2. Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 diagnosis and staging working group report. Biol Blood Marrow Transplant. 2015;21(3):389–401. e381

    Article  Google Scholar 

  3. Galban CJ, Boes JL, Bule M, et al. Parametric response mapping as an indicator of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2014;20(10):1592–8.

    Article  Google Scholar 

  4. Williams KM. How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Blood. 2017;129(4):448–55.

    Article  CAS  Google Scholar 

  5. Chien JW, Duncan S, Williams KM, Pavletic SZ. Bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation-an increasingly recognized manifestation of chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2010;16(1 Suppl):S106–14.

    Article  Google Scholar 

  6. Hildebrandt GC, Granell M, Urbano-Ispizua A, et al. Recipient NOD2/CARD15 variants: a novel independent risk factor for the development of bronchiolitis obliterans after allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2008;14(1):67–74.

    Article  Google Scholar 

  7. Holbro A, Lehmann T, Girsberger S, et al. Lung histology predicts outcome of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2013;19(6):973–80.

    Article  Google Scholar 

  8. Yousem SA. The histological spectrum of pulmonary graft-versus-host disease in bone marrow transplant recipients. Hum Pathol. 1995;26(6):668–75.

    Article  CAS  Google Scholar 

  9. Gazourian L, Spring L, Meserve E, et al. Pulmonary clinicopathological correlation after allogeneic hematopoietic stem cell transplantation: an autopsy series. Biol Blood Marrow Transplant. 2017;23(10):1767–72.

    Article  Google Scholar 

  10. Barker AF, Bergeron A, Rom WN, Hertz MI. Obliterative bronchiolitis. N Engl J Med. 2014;370(19):1820–8.

    Article  CAS  Google Scholar 

  11. Gazourian L, Ash S, Meserve EEK, et al. Quantitative computed tomography assessment of bronchiolitis obliterans syndrome after lung transplantation. Clin Transplant. 2017;31(5).

    Article  Google Scholar 

  12. Greenland JR, Jones KD, Hays SR, et al. Association of large-airway lymphocytic bronchitis with bronchiolitis obliterans syndrome. Am J Respir Crit Care Med. 2013;187(4):417–23.

    Article  CAS  Google Scholar 

  13. Beschorner WE, Saral R, Hutchins GM, Tutschka PJ, Santos GW. Lymphocytic bronchitis associated with graft-versus-host disease in recipients of bone-marrow transplants. N Engl J Med. 1978;299(19):1030–6.

    Article  CAS  Google Scholar 

  14. O’Brien KD, Hackman RC, Sale GE, et al. Lymphocytic bronchitis unrelated to acute graft-versus-host disease in canine marrow graft recipients. Transplantation. 1984;37(3):233–8.

    Article  Google Scholar 

  15. Watanabe J, Sato K, Fujikura Y, et al. Tracheobronchomalacia after allogeneic BMT; pulmonary function test findings similar to those of bronchiolitis obliterans. Bone Marrow Transplant. 2014;49(11):1450–1.

    Article  CAS  Google Scholar 

  16. Freudenberger TD, Madtes DK, Curtis JR, Cummings P, Storer BE, Hackman RC. Association between acute and chronic graft-versus-host disease and bronchiolitis obliterans organizing pneumonia in recipients of hematopoietic stem cell transplants. Blood. 2003;102(10):3822–8.

    Article  CAS  Google Scholar 

  17. Cheng GS, Stednick ZJ, Madtes DK, Boeckh M, McDonald GB, Pergam SA. Decline in the use of surgical biopsy for diagnosis of pulmonary disease in hematopoietic cell transplantation recipients in an era of improved diagnostics and empirical therapy. Biol Blood Marrow Transplant. 2016;22(12):2243–9.

    Article  Google Scholar 

  18. Kono Y, Tsushima K, Yamaguchi K, et al. The utility of galactomannan antigen in the bronchial washing and serum for diagnosing pulmonary aspergillosis. Respir Med. 2013;107(7):1094–100.

    Article  Google Scholar 

  19. Letourneau AR, Issa NC, Baden LR. Pneumonia in the immunocompromised host. Curr Opin Pulm Med. 2014;20(3):272–9.

    Article  Google Scholar 

  20. Atilla E, Sahin D, Atilla PA, et al. Upper respiratory viral infections in patients with haematological malignancies after allogeneic haematopoietic stem cell transplantation: a retrospective study. Antivir Ther. 2018.

    Google Scholar 

  21. Pergam SA. Fungal pneumonia in patients with hematologic malignancies and hematopoietic cell transplantation. Clin Chest Med. 2017;38(2):279–94.

    Article  Google Scholar 

  22. Hill JA, Mayer BT, Xie H, et al. The cumulative burden of double-stranded DNA virus detection after allogeneic HCT is associated with increased mortality. Blood. 2017;129(16):2316–25.

    Article  CAS  Google Scholar 

  23. Sivagnanam S, Pergam SA. Legionellosis in transplantation. Curr Infect Dis Rep. 2016;18(3):9.

    Article  Google Scholar 

  24. Michaud G, Reddy C, Ernst A. Whole-lung lavage for pulmonary alveolar proteinosis. Chest. 2009;136(6):1678–81.

    Article  Google Scholar 

  25. Huang Z, Yi X, Luo B, et al. Induced sputum deposition improves diagnostic yields of pulmonary alveolar proteinosis: a clinicopathological and methodological study of 17 cases. Ultrastruct Pathol. 2016;40(1):7–13.

    Article  Google Scholar 

  26. Hirschmann JV, Pipavath SN, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 2009;29(7):1921–38.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Cecilia C. S. Yeung & Howard M. Shulman

  2. Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA

    Cecilia C. S. Yeung & Howard M. Shulman

  3. Pathology Section, Seattle Cancer Care Alliance, Seattle, WA, USA

    Cecilia C. S. Yeung, Sahl Ali & Howard M. Shulman

Authors
  1. Cecilia C. S. Yeung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sahl Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Howard M. Shulman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cecilia C. S. Yeung .

Editor information

Editors and Affiliations

  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Cecilia C. S. Yeung

  2. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Howard M. Shulman

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Yeung, C.C.S., Ali, S., Shulman, H.M. (2019). Noninfectious Pulmonary Manifestation of GVHD: Bronchiolitis Obliterans Syndrome. In: Yeung, C., Shulman, H. (eds) Pathology of Graft vs. Host Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-42099-8_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42099-8_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42098-1

  • Online ISBN: 978-3-319-42099-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation