Skip to main content


Log in

The Rare Complication and Diagnostic Challenges of Pulmonary Eosinophilia in Graft versus Host Disease Patients after Hematopoietic Stem Cell Transplantation

  • Published:
Lung Aims and scope Submit manuscript



Chronic graft versus host disease (cGvHD) is a common complication of hematopoietic stem cell transplantation (HSCT). Eosinophilic lung disease is a rare poorly understood complication in HSCT patients with cGvHD. These patients present similarly to those with Acute Eosinophilic Pneumonia (AEP). The purpose of this study is to better elucidate the presentation and potential treatment of this phenomenon.


We reviewed over 170 bronchoscopies in post-HSCT patients with respiratory symptoms. Of these, four patients, whose course was complicated by cGvHD, presented with respiratory symptoms, diffuse ground-glass opacities (GGO) on chest computerized tomography (CT), bronchoalveolar lavage (BAL) eosinophilia, and no evidence of infection. The clinical course of these patients was reviewed.


Despite clinical presentation similar to AEP, not all patients had > 25% eosinophils on BAL, one criterion for AEP, however all improved with steroids. Steroid initiation was often delayed in favor of empiric antibiotics despite negative infectious workup. Several patients had recurrent episodes. Regarding possible associations, we examined but found no link between particular demographics, reason for HSCT, chemotherapy, immunosuppressants, or peripheral eosinophil count and pulmonary eosinophilia in these patients. GGO present on initial CT imaging became chronic in several of these patients.


We propose that in post-HSCT patients with GvHD presenting with respiratory symptoms, GGO on CT, BAL eosinophilia of > 10%, and negative respiratory cultures, an autoimmune eosinophilic process may be occurring. Earlier recognition and initiation of corticosteroids in these patients may improve their outcomes as an autoimmune diagnosis was often delayed in favor of antibiotics.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Copelan E (2006) Hematopoietic stem-cell transplantation. N Engl J Med 354(17):1813–1826

    Article  CAS  PubMed  Google Scholar 

  2. Pena E, Souza C, Escuissato D, Gomes M, Allan D, Tay J et al (2014) Noninfectious pulmonary complications after hematopoietic stem cell transplantation: practical approach to imaging diagnosis. Radiographic 34(3):663–683

    Article  Google Scholar 

  3. Yoshimi M, Nannya Y, Watanabe T, Asai T, Ichikawa M, Yamamoto G et al (2009) Acute eosinophilic pneumonia is a non-infectious lung complication after allogeneic hematopoietic stem cell transplantation. Int J Hematol 89:244–248

    Article  PubMed  Google Scholar 

  4. Wagner T, Dhedin N, Philippe B, Rivaud E, Vernant J, Couderc L (2006) Acute eosinophilic pneumonia after allogeneic hematopoietic stem cell transplantation. Ann Hematol 85:202–203

    Article  PubMed  Google Scholar 

  5. Gross T, Hoge F, Jackson J, Sammut P, Warkentin P (1994) Fatal eosinophilic disease following autologous bone marrow transplantation. Bone Marrow Transplant 14(2):333–337

    CAS  PubMed  Google Scholar 

  6. Richard C, Calavia J, Loyola I, Baró J, Cuadrado M, Gómez-Casares M et al (1994) Chronic eosinophilic pneumonia in a patient treated with allogeneic bone marrow transplantation. Med Clin 102:462–464

    CAS  Google Scholar 

  7. Akhtari M, Langston A, Waller E, Gal A (2009) Eosinophilic pulmonary syndrome as a manifestation of GvHD following hematopoietic stem cell transplantation in three patients. Bone Marrow Transplant 43:155–158

    Article  CAS  PubMed  Google Scholar 

  8. Allen J, David W (1994) Eosinophilic lung disease. Am J Respir Crit Care Med 150:1423–1438

    Article  CAS  PubMed  Google Scholar 

  9. Badesch D, King T Jr, Schwarz M (1989) Acute eosinophilic pneumonia: a hypersensitivity phenomenon. Am Rev Respir Dis 139(1):249–252

    Article  CAS  PubMed  Google Scholar 

  10. Yen K, Lee A, Krowka M, Burger C (2004) Pulmonary complications in bone marrow transplantation: a practical approach to diagnosis and treatment. Clin Chest Med 25:189–201

    Article  PubMed  Google Scholar 

  11. Bergeron A, Feuillet S, Meignin V, Socie G, Tazi A (2008) Late onset, non-infectious pulmonary complications after haematological stem cell transplantation. Rev Mal Respir 25(2):173–183

    Article  CAS  PubMed  Google Scholar 

  12. Hildebrandt G, Fazekas T, Lawitschka A, Bertz H, Greinix H, Halter J et al (2011) Diagnosis and treatment of pulmonary chronic GvHD: report from the consensus conference on clinical practice in chronic GvHD. Bone Marrow Transplant 46:1283–1295

    Article  CAS  PubMed  Google Scholar 

  13. Sakaida E, Nakaseko C, Harima A, Yokota A, Cho R, Saito Y et al (2003) Late-onset noninfectious pulmonary complications after allogeneic stem cell transplantation are significantly associated with chronic graft-versus-host disease and with the graft-versus-leukemia effect. Blood 102:4236–4242

    Article  CAS  PubMed  Google Scholar 

  14. Splitzer T (2001) Engraftment syndrome following hematopoietic stem cell transplantation. Bone Marrow Transplant 27:893–898

    Article  Google Scholar 

  15. Filipovich A, Weisdorf D, Pavletic S, Socie G, Wingard J, Lee S et al (2015) National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 21(8):1343–1359

    Article  Google Scholar 

  16. Kalaycioglu M, Bolwell B (1994) Eosinophilia after allogeneic bone marrow transplantation using the busulfan and cyclophosphamide preparative regimen. Bone Marrow Transplant 14:113–115

    CAS  PubMed  Google Scholar 

  17. Ahmad I, Labbe A, Chagnon M, Busque L, Cohen S, Kiss T et al (2011) Incidence and prognostic value of eosinophilia in chronic graft-versus-host disease after nonmyeloablative hematopoietic cell transplantation. Biol Blood Marrow Transplant 17(11):1673–1678

    Article  PubMed  Google Scholar 

  18. Imahashi N, Miyamura K, Seto A, Watanabe K, Yanagisawa M, Nishiwaki S et al (2010) Eosinophilia predicts better overall survival after acute graft-versus-host disease. Bone Marrow Transplant 45:371–377

    Article  CAS  PubMed  Google Scholar 

  19. Fulkerson P, Rothenberg M (2013) Targeting Eosinophils in Allergy, Inflammation and Beyond. Nat Rev Drug Discov 12(2):117–129

    Article  CAS  PubMed  Google Scholar 

  20. Kaya J, Gümüş S, Uçar E, Aydoğan M, Muşabak U, Tozkoparan E et al (2012) Omalizumab as a steroid-sparing agent in chronic eosinophilic pneumonia. Chest 142(2):513–516

    Article  CAS  PubMed  Google Scholar 

Download references


The authors would like to thank the University of Minnesota Medical Center and the Blood and Marrow Transplantation division for the collegiate atmosphere that enabled this research.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Pierre Tawfik.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consents

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tawfik, P., Arndt, P. The Rare Complication and Diagnostic Challenges of Pulmonary Eosinophilia in Graft versus Host Disease Patients after Hematopoietic Stem Cell Transplantation. Lung 195, 805–811 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: