Palmas A, Tefferi A, Myers J L, Scott J P, Swensen S J, Chen M G, Gastineau D A, Gertz M A, Inwards D J, Lacy M Q, Litzow M R
Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Br J Haematol. 1998 Mar;100(4):680-7. doi: 10.1046/j.1365-2141.1998.00617.x.
We examined the incidence and clinical outcome of late-onset noninfectious pulmonary complications (LONIPC) in a series of 234 patients who underwent allogeneic bone marrow transplantation at our institution between April 1982 and October 1996. The 179 patients who survived 3 months or more were evaluated. Clinical, radiologic, pulmonary function, and pathologic tests were reviewed to identify 18 patients (10%) who fulfilled the diagnostic criteria of LONIPC. Accordingly, the pulmonary processes included bronchiolitis obliterans (BO, five patients), bronchiolitis obliterans with organizing pneumonia (BOOP, three patients), diffuse alveolar damage (DAD, one patient), lymphocytic interstitial pneumonia (LIP, one patient), and nonclassifiable interstitial pneumonia (NCIP, eight patients). Various methods of enhanced immunosuppressive therapy resulted in marked durable remission in nine patients (50%) (3/3 with BOOP, 3/8 with NCIP, 1/1 with DAD, 1/1 with LIP, 1/5 with BO). The presence of chronic graft-versus-host disease (cGVHD) and prophylaxis for GVHD with cyclosporine and prednisone were the only variables significantly associated with the development of LONIPC (P = 0.0001 and 0.008, respectively). Regardless of histology, a reduction in the forced expiratory volume to < 45% of the predicted range was associated with poor response to treatment. These findings suggest a strong association between cGVHD and LONIPC and that the risk of LONIPC development may be influenced by the particular method of GVHD prophylaxis. Most patients with BOOP or mild airflow limitation at diagnosis achieved durable remissions.
我们对1982年4月至1996年10月间在我院接受异基因骨髓移植的234例患者中迟发性非感染性肺部并发症（LONIPC）的发生率及临床结局进行了研究。对存活3个月或更长时间的179例患者进行了评估。回顾临床、放射学、肺功能和病理学检查结果，以确定符合LONIPC诊断标准的18例患者（10%）。因此，肺部病变包括闭塞性细支气管炎（BO，5例）、闭塞性细支气管炎伴机化性肺炎（BOOP，3例）、弥漫性肺泡损伤（DAD，1例）、淋巴细胞间质性肺炎（LIP，1例）和不可分类的间质性肺炎（NCIP，8例）。各种强化免疫抑制治疗方法使9例患者（50%）（BOOP患者3/3、NCIP患者3/8、DAD患者1/1、LIP患者1/1、BO患者1/5）获得了显著持久的缓解。慢性移植物抗宿主病（cGVHD）的存在以及用环孢素和泼尼松预防移植物抗宿主病是与LONIPC发生显著相关的唯一变量（P分别为0.0001和0.008）。无论组织学类型如何，用力呼气量降至预测范围的<45%与治疗反应不佳相关。这些发现表明cGVHD与LONIPC之间存在密切关联，并且LONIPC发生的风险可能受预防移植物抗宿主病的特定方法影响。大多数诊断时患有BOOP或轻度气流受限的患者实现了持久缓解。
