Comparison between non–HCT-OP and HCT-OP
| Non–HCT-OP . | HCT-OP . |
|---|---|
| Patient population | |
| Rarely reported in children | Any allogeneic HCT recipient |
| Can be cryptogenic or associated with other processes (infection, drug toxicity, or radiation) | Isolated occurrence without other GVHD in other organs is rare Associated with GVHD of other organs, especially mouth and skin |
| Diagnosis | |
| Lung biopsy is pursued to confirm diagnosis or rule out secondary causes | Lung biopsy is reserved for selective cases given the high risk of postprocedural complications |
| Lower lung zone preference | No zonal preference |
| Recurrence can present with migratory opacities or different radiographic features as to index event | Recurrence tends to occur at the same location with similar radiographic features as to index event |
| Treatment | |
| Spontaneous resolution can be observed | Spontaneous resolution is rare |
| Extended period of corticosteroid for 6-12 mo may be necessary | Extended corticosteroid course >6-12 mo is often required |
| Prognosis | |
| Relapse rate of 13%-58%7 | Relapse rate of 30%-50% |
| Mortality is <10%; death often unrelated to OP | Higher death rate from respiratory failure12 |
| Excellent prognosis, with 5-y survival >90%1 | Prognosis is less favorable20 |
| Corticosteroid-sparing agents∗ | |
| Mycophenolate mofetil, azithromycin, cyclosporine, rituximab | Mycophenolate mofetil, ruxolitinib, cyclosporine |
| Non–HCT-OP . | HCT-OP . |
|---|---|
| Patient population | |
| Rarely reported in children | Any allogeneic HCT recipient |
| Can be cryptogenic or associated with other processes (infection, drug toxicity, or radiation) | Isolated occurrence without other GVHD in other organs is rare Associated with GVHD of other organs, especially mouth and skin |
| Diagnosis | |
| Lung biopsy is pursued to confirm diagnosis or rule out secondary causes | Lung biopsy is reserved for selective cases given the high risk of postprocedural complications |
| Lower lung zone preference | No zonal preference |
| Recurrence can present with migratory opacities or different radiographic features as to index event | Recurrence tends to occur at the same location with similar radiographic features as to index event |
| Treatment | |
| Spontaneous resolution can be observed | Spontaneous resolution is rare |
| Extended period of corticosteroid for 6-12 mo may be necessary | Extended corticosteroid course >6-12 mo is often required |
| Prognosis | |
| Relapse rate of 13%-58%7 | Relapse rate of 30%-50% |
| Mortality is <10%; death often unrelated to OP | Higher death rate from respiratory failure12 |
| Excellent prognosis, with 5-y survival >90%1 | Prognosis is less favorable20 |
| Corticosteroid-sparing agents∗ | |
| Mycophenolate mofetil, azithromycin, cyclosporine, rituximab | Mycophenolate mofetil, ruxolitinib, cyclosporine |
Refer to Table 4 for detail.