Respiratory conditions associated with haematological malignancies
Authors: M. Wickremasinghe
Journal: Thorax (1997)

The case reports by Morehead 1 and Charo-Pseudomonas aeruginosa often occurs in these enratanakul and Loasuthi 2 highlight some unpatients, allowing host mediated inflammatory common but important respiratory conditions damage to ensue as part of the vicious circle.associated with haematological malignancies.Some insights into chronic GVHD as-Distal airway disease is a well recognised sociated bronchiectasis may be gleaned from complication of allogeneic bone marrow transbronchiectasis associated with the obliterative plantation.This follows the first reports of bronchiolitis complicating heart-lung transrapidly progressive often fatal irreversible airplantation.Here the obliterative bronchiolitis is flow obstruction due to obliterative bronconsidered a manifestation of allograft rejection chiolitis in patients invariably suffering from and bears some immunological similarity to chronic graft versus host disease (GVHD). 3obliterative bronchiolitis associated with Proximal airway disease in these patients, as chronic GVHD.Retrospective studies of high described in the cases reported by Morehead, 1 is resolution computed tomographic (HRCT) less formally described in the literature.Isolated scans following heart-lung and lung transreports have alluded to patients progressing to plantation have clearly shown bronchiectasis as bronchiectatic-like syndromes, providing some one of the most consistent radiological findings limited clinical evidence of concomitant proxof obliterative bronchiolitis. 5This predominimal airways involvement in chronic GVHD antly segmental and subsegmental bronchial associated airflow obstruction. 4 dilatation correlates with the severity of airflow There are numerous potential pathogenetic obstruction.Interest in this finding has therefactors for the development of bronchiectasis fore centred on its potential use as a marker for in patients with chronic GVHD, many of which the early detection of obliterative bronchiolitis.overlap with those for obliterative bronchiolitis.Preliminary studies suggest the bronchiectasis The vicious circle hypothesis for the pathoto be a concomitant rather than antecedent genesis of bronchiectasis suggests that an initial feature of obliterative bronchiolitis related airtriggering lung insult compromises sinoflow obstruction in these patients.pulmonary mucociliary clearance mechanisms Evidence of lower lobe bronchial dilatation predisposing to microbial colonisation.Much on the HRCT scan has also been observed of the subsequent airway damage is due to a in patients with symptomatic chronic GVHD host mediated inflammatory response to this associated airflow obstruction who undergo persistent intraluminal microbial stimulus.bone marrow transplantation. 6However, no This initial airway insult in patients who prospective imaging study has been done to undergo allogeneic bone marrow transplantation establish when, in the evolution of chronic may follow cytotoxic therapy and irradiation GVHD associated airways disease, bronchial used in conditioning regimes or recurrent asdilatation begins.Its relationship to and usepiration of gastric contents secondary to oesofulness as a marker of obliterative bronchiolitis phageal chronic GVHD.Evidence of direct in bone marrow transplantation is therefore immune mediated damage to the airway by unknown.chronic GVHD has yet to be firmly established.In view of the many predisposing factors for However, host bronchial epithelial cells could the development of chronic GVHD related serve as targets for donor T lymphocyte and bronchiectasis it may seem surprising that clincytokine mediated damage.Bronchial and subically overt disease has not been reported more mucosal gland lymphocytic infiltrates have commonly.Chronic GVHD in combination been found in GVHD but may be the sequelae with the other lung insults mentioned may of multiple lung insults rather than a specific cause more widespread airways disease than manifestation of lung GVHD.The sinopreviously appreciated.Early on the proximal bronchial sicca resulting from this submucosal disease may exist subclinically, detectable by gland destruction will compromise mucociliary HRCT scanning as bronchial dilatation.The transport.rate of progression of this proximal disease, Airway damage may follow the recurrent however, may lag behind the more aggressive sinopulmonary infections common in chronic Hammersmith distal disease, with bronchiectasis only oc-GVHD.This increased susceptibility to in-Hospital, London curring as a late manifestation in those who fection is due to severe persistent combined W12 0NN, UK survive long enough.Immunosuppressive cellular and humoral immune deficiency char-M Wickremasinghe agents, in addition to conventional bronchiacteristic of chronic GVHD.Microbial col