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. 2017 Oct;23(10):1767-1772.
doi: 10.1016/j.bbmt.2017.06.009. Epub 2017 Jun 28.

Pulmonary Clinicopathological Correlation after Allogeneic Hematopoietic Stem Cell Transplantation: An Autopsy Series

Lee Gazourian  1 , Laura Spring  2 , Emily Meserve  3 , David Hwang  3 , Alejandro A Diaz  4 , Samuel Y Ash  4 , Vincent T Ho  2 , Lynette M Sholl  3 , George R Washko  4
Affiliations

Pulmonary Clinicopathological Correlation after Allogeneic Hematopoietic Stem Cell Transplantation: An Autopsy Series

Lee Gazourian et al. Biol Blood Marrow Transplant. 2017 Oct.

Abstract

Pulmonary complications are a significant cause of morbidity, mortality, and resource utilization after hematopoietic stem cell transplantation (HSCT). The objective of this study was to compare antemortem clinical suspicion of pulmonary complications and postmortem findings in a modern HSCT cohort. All patients who underwent allogeneic HSCT at our institution (n = 1854) between January 1, 2000 and June 30, 2010 were reviewed and patients who died of any cause greater than 1 year after HSCT and had an unrestricted autopsy available for analysis were included. Presence of pulmonary graft-versus-host disease (GVHD) was assessed by a pathologist blinded to the autopsy report, as previously described by Yousem (1995). A total of 35 (1.9%) patients had autopsies available for review. Airway disease, vascular disease, and interstitial disease were all clinically under-recognized compared with the pathological findings on autopsy. Varying degrees of pathological changes were detected, including 10 (28.6%) patients having bronchiolitis obliterans (BO) and 12 (34.3%) patients having pulmonary veno-occlusive disease (PVOD). Pulmonary manifestations of chronic GVHD, particularly BO and PVOD, were clinically under-recognized in our cohort. Our results suggest that PVOD, which has traditionally been considered a rare complication, may be clinically and histologically under-recognized.

Keywords: Autopsy; Graft-versus-host disease; Hematopoietic stem cell transplantation.

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Conflict of interest statement

Conflict of interest statement: There are no conflicts of interest to report.

Figures

Figure 1
Figure 1
Airways disease. (A) Shows lymphocytic bronchitis/bronchiolitis and (B) shows bronchiolitis obliterans.
Figure 2
Figure 2
Pulmonary venous disease. Septal edema and narrowing of septal veins by myxoid connective tissue.
Figure 3
Figure 3
Disease of the interstitium. (A) Shows cellular interstitial pneumonitis and (B) shows interstitial fibrosi.
See this image and copyright information in PMC

Comment in

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