Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
Blood. 2024 Sep 5;144(10):1048-1060. doi: 10.1182/blood.2023023249.
Organizing pneumonia (OP) is a known noninfectious pulmonary complication following allogeneic hematopoietic cell transplant (HCT) and represents a significant risk factor for nonrelapse mortality in HCT recipients. Unlike bronchiolitis obliterans syndrome, it is not universally acknowledged as a distinctive pulmonary manifestation of chronic graft-versus-host disease (cGVHD) and, therefore, its diagnostic criteria and management approach are lacking. Given its shared similar clinical features and radiological and histologic findings to OP in the non-HCT population, the diagnostic approach and treatment strategy for OP in HCT recipients is largely adapted from the non-HCT population. In this article, we aim to enhance the understanding of OP within the context of cGVHD following HCT and distinguish its clinical features and treatment strategy from non-HCT counterparts, thereby reinforcing its recognition as a pulmonary manifestation of graft-versus-host disease. We will propose the diagnostic criteria and outline our approach in diagnosis and treatment strategy, highlighting the potential challenges that may arise in each process. Finally, we will discuss knowledge gaps in this field and identify the area of need for future research.
机化性肺炎（OP）是异基因造血细胞移植（HCT）后已知的非传染性肺部并发症，是 HCT 受者非复发死亡率的重要危险因素。与闭塞性细支气管炎综合征不同，它并非普遍被认为是慢性移植物抗宿主病（cGVHD）的独特肺部表现，因此缺乏其诊断标准和管理方法。鉴于其与非 HCT 人群中的 OP 具有相似的临床特征、影像学和组织学表现，因此 HCT 受者 OP 的诊断方法和治疗策略主要是从非 HCT 人群中借鉴而来。本文旨在提高对 HCT 后 cGVHD 中 OP 的认识，并将其临床特征和治疗策略与非 HCT 人群区分开来，从而加强对其作为移植物抗宿主病肺部表现的认识。我们将提出诊断标准，并概述我们在诊断和治疗策略方面的方法，重点介绍每个过程中可能出现的潜在挑战。最后，我们将讨论该领域的知识空白，并确定未来研究的需求领域。
