LATE CD8(-VERSUS-HOST DISEASE() LYMPHOCYTIC ALVEOLITIS AFTER ALLOGENEIC GONE MARROW TRANSPLANTATION AND CHRONIC GRAFT)

Late-onset interstitial pneumonitis following allogeneic bone marrow t ransplantation (BMT) is a rare condition usually caused by a variety o f infective agents, although in some cases these are idiopathic. We in vestigated noninfectious late interstitial pneumonitis with lymphocyti c alveolitis in seven allogeneic BMT recipients using bronchoalveolar lavage (BAL), lymphocyte phenotyping analysis, CT lung scans, and pulm onary function tests. The results were compared with those of a contro l group composed of similar patients with no pulmonary symptoms. Of 65 long-term survivors, seven were included in the study. All had chroni c graft-versus-host disease (GVHD) and developed interstitial pneumoni tis a median of 210 d (range 120 to 445 d) after BMT. BAL revealed lym phocytosis, with an overall expansion of CD8(+) subsets (38 to 90%). L ymphocytic alveolitis was not observed in the control group. Pulmonary function tests revealed a restrictive syndrome, and biopsy samples ob tained from 2 patients showed interstitial lymphoid infiltration with fibrosis of the alveolar walls. Of the 7 patients, six were cured by s tarting immunosuppressive drugs or increasing the dosage with a drasti c improvement in respiratory symptoms within 1 mo. These findings sugg est that CD8(+) alveolitis may be observed in late interstitial pneumo nitis in allogeneic BMT recipients and may be a pulmonary manifestatio n of chronic GVHD.