Association Between Acute Graft Versus Host Disease and Lung Injury after Allogenic Hematopoietic Stem Cell Transplantation

To investigate the characteristics of chest computed tomography (CT) and pathogenesis of acute graft versus host disease(GVHD)-induced lung injury after allogenic hematopoietic stem cell transplantation. In 47 patients with acute GVHD of grade II–IV, CT showed abnormalities in 20 patients in which 17 cases were suspected of acute GVHD-induced lung injury. Of 17 patients, CT revealed diffused interstitial infiltrate in 5 cases, diffused interstitial and alveolar infiltrate in 7 cases,diffused interstitial and segmental lobar alveolar infiltrate in 5 cases. The levels of serum IFNγ and TNFα in patients were higher than those of the healthy group. The histopathology of lung showed disorganization, epithelial cell damage, interstitial fibroplasias and interstitial T cell or macrophage infiltrate. In 24 patients who survived more than 6 months, 3 cases each in cases with and without lung injury developed late-onset noninfectious lung injury; 11 patients had abnormal pulmonary function including 7 patients in 9 patients with lung injury and 4 patients in 15 patients without lung injury. We concluded that T cell, macrophage, IFNγ and TNFα might play a role in the pathogenesis of acute GVHD-induced lung injury. Acute GVHD-induced lung injury might progress to late-onset noninfectious lung injury.