Elsevier

Respiratory Medicine

Volume 101, Issue 1, January 2007, Pages 162-168
Respiratory Medicine

Organizing pneumonia in patients with hematologic malignancies: A steroid-responsive lesion

https://doi.org/10.1016/j.rmed.2006.03.035Get rights and content
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Summary

Background

Organizing pneumonia (OP) is a distinct histopathologic lesion that occurs in a variety of clinical contexts. There have been occasional reports of OP occurring in patients with hematologic malignancies.

Study objectives

To examine the association of OP with hematologic malignancies and to assess the clinical course of affected patients.

Design

A retrospective review of our institutional experience of unexplained OP developing in patients with hematologic malignancies.

Setting

Tertiary care, referral medical center.

Patients

We identified 6 patients with a verified histopathologic diagnosis of OP and antecedent or concomitant diagnosis of a hematologic malignancy from the Mayo Clinic database (1995–2003). Clinical, radiologic, and outcome data were abstracted from records.

Results

Underlying hematologic disorders included lymphoma (2), acute leukemia (2), cutaneous T-cell lymphoma (1), and myelodysplastic syndrome (1). OP was diagnosed by surgical lung biopsy in 4 and bronchoscopic biopsy in 2. Four of the 6 patients had previously been exposed to chemotherapeutic agents, two had not. Three of the 6 patients had bone marrow transplantation prior to development of OP. Five patients were treated with prednisone and all experienced symptomatic improvement with documented radiologic resolution in 4. One patient experienced symptomatic and radiologic resolution with observation alone. Three patients ultimately died from complications of their underlying hematologic disorder and 1 patient died of unknown causes. Two patients were alive without respiratory complaints more than 1 year after lung biopsy.

Conclusions

OP occurs in patients with underlying hematologic malignancies who may or may not have been treated with chemotherapy and responds favorably to corticosteroid therapy.

Keywords

Organizing pneumonia
Bronchiolitis obliterans organizing
Pneumonia
Leukemia
Lymphoma
Interstitial lung disease

Abbreviations

ALL
acute lymphocytic leukemia
AML
acute myelogenous leukemia
BMT
bone marrow transplantation
BOOP
bronchiolitis obliterans organizing pneumonia
CML
chronic myelogenous leukemia
CMML
chronic myelomonocytic leukemia
CT
computed tomography
COP
cryptogenic organizing pneumonia
FFB
flexible fiberoptic bronchoscopy
GVHD
graft-versus-host disease
IV
intravenous
MDS
myelodysplastic syndrome
NHL
non-Hodgkin's lymphoma
OP
organizing pneumonia
RAEB
refractory anemia with excess blasts
TBLB
transbronchoscopic lung biopsy

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Funding: Mayo Institutional funds.