Pleuroparenchymal fibroelastosis and non-specific interstitial pneumonia: frequent pulmonary sequelae of haematopoietic stem cell transplantation
Pleuroparenchymal fibroelastosis and non-specific interstitial pneumonia: frequent pulmonary sequelae of haematopoietic stem cell transplantation
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DOI：
10.1111/his.12553
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发表时间：
2015-03-01
期刊：
影响因子：
6.4
通讯作者：
Haga, Hironori
中科院分区：
文献类型：
--
作者：
Takeuchi, Yasuhide;Miyagawa-Hayashino, Aya;Haga, Hironori
目的慢性移植物抗宿主病（cGVHD）在造血干细胞移植（HSCT）后的肺后遗症包括缩窄性闭塞性细支气管炎（CBO）、淋巴细胞性细支气管炎（LB）和静脉闭塞性疾病（VOD）；最近，骨髓移植受者也出现了胸膜实质纤维弹性增生（PPFE）。肺HSCT后遗症的组织学特征尚未有系统的描述。本研究的目的是回顾和确定骨髓移植后PPFE的组织学特征。方法与结果回顾性分析2004 - 2013年间20例HSCT术后肺移植患者的临床资料。移植时患者年龄从8岁到57岁不等（中位27.5岁）。其他器官cGVHD患者15例（皮肤9例，肝脏6例，唾液腺6例）。肺移植的中位时间为hsct后4.6年（1.2-14.8年）。组织学上，所有病例均有CBO， 10例合并LB， 3例合并VOD。15例（75%）发现PPFE，分布在胸膜下（15）、隔旁（11）和小叶中心（13）；非特异性间质性肺炎（NSIP） 15例（75%），其中纤维化型（9例）和细胞型（6例）。PPFE分布于各肺叶，以上肺叶为主。NSIP多为局灶性，2例为弥漫性受累。结论sppfe和NSIP在HSCT患者中较为常见。可能的原因包括对药物、辐射或cGVHD的反应。
AimsPulmonary sequelae, reported as chronic graft-versus-host disease (cGVHD), of haematopoietic stem cell transplantation (HSCT) include constrictive bronchiolitis obliterans (CBO), lymphocytic bronchiolitis (LB), and veno-occlusive disease (VOD); recently, pleuroparenchymal fibroelastosis (PPFE) has also been described in bone marrow transplant recipients. The histological features of pulmonary HSCT sequelae have not been described systematically. The aim of the study was to review and identify the histological features of PPFE after bone marrow transplant.Methods and resultsA retrospective review of 20 patients who underwent lung transplantation for pulmonary disease following HSCT between 2004 and 2013 was conducted. The patient age at transplantation ranged from 8years to 57years (median, 27.5years). Fifteen patients had cGVHD in other organs (skin, nine; liver, six; salivary gland, six). Lung transplantation was performed at a median of 4.6years (range, 1.2-14.8years) post-HSCT. Histologically, all cases had CBO, with concurrent LB in 10, and VOD in three. PPFE was identified in 15 cases (75%), with subpleural (15), paraseptal (11) and centrilobular (13) distributions; and non-specific interstitial pneumonia (NSIP) was identified in 15 cases (75%), with fibrotic (nine) and cellular (six) patterns. PPFE was distributed in all lobes, with a predominance in the upper lobe. NSIP was mostly focal, with two cases having diffuse involvement.ConclusionsPPFE and NSIP were frequently seen in HSCT patients. Possible causes may include reactions to drugs or radiation, or cGVHD.