Veronique Meignin1, Francoise Thivolet-Bejui2, Marianne Kambouchner3, Claire Hussenet4, Louise Bondeelle4, Andrew Mitchell5, Karine Chagnon6, Hugues Begueret7, Valerie Segers8, Vincent Cottin9,10, Abdellatif Tazi4, Sylvie Chevret11,12, Claire Danel13,14, Anne Bergeron4,12. 1. Service de Pathologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France. 2. Service de Pathologie, Groupement hospitalier est, Hospices de Lyon, Université Claude Bernard Lyon Est, Lyon, France. 3. Service de Pathologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France. 4. Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France. 5. Service de Pathologie, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Canada. 6. Service de Pneumologie, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Canada. 7. Service de Pathologie, Hôpital Haut Lévêque, Groupe hospitalier sud, CHU de Bordeaux, Bordeaux, France. 8. Service de Pathologie, CHU Brugmann, Bruxelles, Belgique. 9. Service de pneumologie, Hospices Civils de Lyon, Lyon, France. 10. Hôpital Louis Pradel, Centre de référence national des maladies pulmonaires rares et Centre de compétences de l'hypertension artérielle pulmonaire, Université de Lyon, Université Claude Bernard Lyon, Lyon, France. 11. Service de Biostatistique et Information médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France. 12. Biostatistics and Clinical Epidemiology Research Team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 13. Département de Pathologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France. 14. Université Paris-Diderot, Sorbonne, Paris Cité, Paris, France.
Abstract
AIMS: Non-infectious pulmonary complications (NIPCs) occur frequently following allogeneic haematopoietic stem cell transplantation (HSCT). As there is no consensus on the description of the related pulmonary pathological lesions, pathologist reports and clinical conclusions are largely inconsistent in routine practice. The aim of our study was to provide an accurate overview of post-allogeneic HSCT NIPCs from a large number of lung biopsies. METHODS AND RESULTS: We reviewed 61 lung biopsies in patients with an NIPC, including 51 surgical lung biopsies, four post-mortem biopsies and six lung explants. We found both bronchiolar (n = 59) and alveolar/interstitial pathologies (n = 27). We describe two types of bronchiolar lesions: bronchiolectasies (n = 37) and fibrous and cellular lesions with luminal narrowing (n = 43). We found a wide spectrum of airway/interstitial pathologies that were labelled using the terminology of the 2013 American Thoracic Society and European Respiratory Society (ATS/ERS) classification of idiopathic interstitial pneumonias (IIPs), including the following: organising pneumonia (OP, n = 8), non-specific interstitial pneumonia (NSIP, n = 9), diffuse alveolar damage (DAD, n = 6), lymphoid interstitial pneumonia (LIP, n = 1) and pleuroparenchymal fibroelastosis (PPFE, n = 2), as well as one instance of associated PPFE and NSIP. CONCLUSIONS: Interstitial pathology was associated with bronchiolar lesions in 41% of the cases reviewed (n = 25). Lung airway and interstitial inflammation was still present in lung explants from patients who underwent lung transplantation for post-allogeneic HSCT end-stage respiratory insufficiency. Herein, we describe a wide spectrum of pathological lung lesions encountered in post-allogeneic HSCT NIPCs.
AIMS: Non-infectious pulmonary complications (NIPCs) occur frequently following allogeneic haematopoietic stem cell transplantation (HSCT). As there is no consensus on the description of the related pulmonary pathological lesions, pathologist reports and clinical conclusions are largely inconsistent in routine practice. The aim of our study was to provide an accurate overview of post-allogeneic HSCT NIPCs from a large number of lung biopsies. METHODS AND RESULTS: We reviewed 61 lung biopsies in patients with an NIPC, including 51 surgical lung biopsies, four post-mortem biopsies and six lung explants. We found both bronchiolar (n = 59) and alveolar/interstitial pathologies (n = 27). We describe two types of bronchiolar lesions: bronchiolectasies (n = 37) and fibrous and cellular lesions with luminal narrowing (n = 43). We found a wide spectrum of airway/interstitial pathologies that were labelled using the terminology of the 2013 American Thoracic Society and European Respiratory Society (ATS/ERS) classification of idiopathic interstitial pneumonias (IIPs), including the following: organising pneumonia (OP, n = 8), non-specific interstitial pneumonia (NSIP, n = 9), diffuse alveolar damage (DAD, n = 6), lymphoid interstitial pneumonia (LIP, n = 1) and pleuroparenchymal fibroelastosis (PPFE, n = 2), as well as one instance of associated PPFE and NSIP. CONCLUSIONS: Interstitial pathology was associated with bronchiolar lesions in 41% of the cases reviewed (n = 25). Lung airway and interstitial inflammation was still present in lung explants from patients who underwent lung transplantation for post-allogeneic HSCT end-stage respiratory insufficiency. Herein, we describe a wide spectrum of pathological lung lesions encountered in post-allogeneic HSCT NIPCs.
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