Am. J. Respir. Crit. Care Med., Vol 150, No. 4, 10 1994, 1056-1061.
Late CD8+ lymphocytic alveolitis after allogeneic bone marrow transplantation and chronic graft-versus-host disease
V Leblond, H Zouabi, L Sutton, JM Guillon, CM Mayaud, T Similowski, C Beigelman and B Autran
Department of Hematology, Pitie-Salpetriere Hospital, Paris, France.
Late-onset interstitial pneumonitis following allogeneic bone marrow
transplantation (BMT) is a rare condition usually caused by a variety of
infective agents, although in some cases these are idiopathic. We
investigated noninfectious late interstitial pneumonitis with lymphocytic
alveolitis in seven allogeneic BMT recipients using bronchoalveolar lavage
(BAL), lymphocyte phenotyping analysis, CT lung scans, and pulmonary
function tests. The results were compared with those of a control group
composed of similar patients with no pulmonary symptoms. Of 65 long-term
survivors, seven were included in the study. All had chronic
graft-versus-host disease (GVHD) and developed interstitial pneumonitis a
median of 210 d (range 120 to 445 d) after BMT. BAL revealed lymphocytosis,
with an overall expansion of CD8+ subsets (38 to 90%). Lymphocytic
alveolitis was not observed in the control group. Pulmonary function tests
revealed a restrictive syndrome, and biopsy samples obtained from 2
patients showed interstitial lymphoid infiltration with fibrosis of the
alveolar walls. Of the 7 patients, six were cured by starting
immunosuppressive drugs or increasing the dosage with a drastic improvement
in respiratory symptoms within 1 mo. These findings suggest that CD8+
alveolitis may be observed in late interstitial pneumonitis in allogeneic
BMT recipients and may be a pulmonary manifestation of chronic GVHD.
