Trisolini R, Stanzani M, Lazzari Agli L, Colangelo A, Bonifazi F, Falcioni S, Patelli M, Falcone F, Bandini G, Tura S, Poletti V
Dipartimento di Malattie del Torace, Ospedali Bellaria e Maggiore, Bologna, Italy.
Sarcoidosis Vasc Diffuse Lung Dis. 2001 Mar;18(1):75-84.
The studies on late-onset non-infectious respiratory complications after allogeneic bone marrow transplantation (allo-BMT) have been mainly focused on bronchiolitis obliterans to date. The aim of this work was to analyze the incidence, clinico-pathologic characteristics and outcome of the entire spectrum of entities falling into the group of delayed non-infectious lung disease (DLD).
Retrospective chart review was carried out of 112 patients who underwent allo-BMT for hematologic malignancies between April 1995 and November 1998 at a single Institution. The categorization of the pulmonary disease was made by analyzing clinical data, bronchoalveolar lavage (BAL), high-resolution computed tomography (HRCT) and histology when possible.
DLD occurred in 10 (10%) out of 97 recipients who survived at least 100 days following allo-BMT and was defined as bronchiolitis obliterans (BO; 4 cases), acute lung injury (ALI; 1 case) and subacute cellular interstitial pneumonia (SCIP; 5 cases). The BAL-profile was characterized by a marked increase of the neutrophil percentage in BO cases and of the lymphocyte (predominantly CD8+) percentage in parenchymal DLDs (SCIP, ALI). HRCT proved to be helpful to correctly identify BO cases, whereas histology was always needed to better define DLD presenting with an interstitial and/or alveolar pattern. The predominant airway involvement as well as the acute-onset of a respiratory illness with histological evidence of diffuse alveolar damage were associated with a worse prognosis because of a poor response to the immunosuppressive treatment.
DLDs represent a group of entities heterogeneous in regard to variables such as onset and clinical behaviour (acute, subacute or chronic), predominant pattern of lung involvement (airway or parenchymal), response to treatment. Although immunopathologic mechanisms related to c-GVHD probably have a relevant pathogenic importance in this setting, the possible role of associated events (eg, drug toxicity and infections) at least in priming the lung damage need to be better clarified for its therapeutical implications.
迄今为止，关于异基因骨髓移植（allo-BMT）后迟发性非感染性呼吸系统并发症的研究主要集中在闭塞性细支气管炎。本研究旨在分析延迟性非感染性肺部疾病（DLD）组中各类疾病的发病率、临床病理特征及转归。
对1995年4月至1998年11月在某单一机构接受allo-BMT治疗血液系统恶性肿瘤的112例患者进行回顾性病历审查。尽可能通过分析临床资料、支气管肺泡灌洗（BAL）、高分辨率计算机断层扫描（HRCT）及组织学对肺部疾病进行分类。
97例allo-BMT后存活至少100天的受者中有10例（10%）发生DLD，其被定义为闭塞性细支气管炎（BO；4例）、急性肺损伤（ALI；1例）和亚急性细胞性间质性肺炎（SCIP；5例）。BAL特征为BO病例中性粒细胞百分比显著升高，实质性DLD（SCIP、ALI）中淋巴细胞（主要为CD8 +）百分比升高。HRCT有助于正确识别BO病例，而对于呈现间质性和/或肺泡性模式的DLD，总是需要组织学来更好地明确诊断。由于对免疫抑制治疗反应不佳，主要气道受累以及伴有弥漫性肺泡损伤组织学证据的呼吸系统疾病急性发作与预后较差相关。
DLD在发病时间和临床行为（急性、亚急性或慢性）、主要肺部受累模式（气道或实质性）、对治疗的反应等变量方面表现为一组异质性疾病。尽管在这种情况下与c-GVHD相关的免疫病理机制可能具有重要的致病意义，但相关事件（如药物毒性和感染）至少在引发肺损伤中的可能作用，因其治疗意义需要更好地阐明。
