Immune check-point inhibitor-related pneumonitis: Acute lung injury with rapid progression and organising pneumonia with less severe clinical disease Journal Article

   

Authors:	Imran, S.; Golden, A.; Feinstein, M.; Plodkowski, A.; Bodd, F.; Rekhtman, N.; Travis, W. D.; Stover, D. E.; Sauter, J. L.
Article Title:	Immune check-point inhibitor-related pneumonitis: Acute lung injury with rapid progression and organising pneumonia with less severe clinical disease
Abstract:	Aims: To improve understanding of the pathology of immune check-point inhibitor (ICI)-related pneumonitis, clinical, radiographic and histopathological features and outcomes were investigated in a cohort of patients who were treatment-naive before receiving ICI inhibition, who underwent lung biopsy, and in whom other potential causes of lung injury were excluded. Methods: Patients were retrospectively identified via searches of institutional pathology and clinical records. Patients treated with other modalities for cancer and patients with lung infections or other aetiologies that could cause pneumonitis were excluded. Clinical records were reviewed by pulmonologists. Imaging studies at presentation and follow-up were reviewed by a thoracic radiologist. Pathology was reviewed by thoracic pathologists. Results: Six patients with ICI-related pneumonitis were identified. Two patients presented with respiratory failure requiring mechanical ventilation, diffuse ground glass opacities (GGOs) on chest computed tomography (CT) and acute lung injury (ALI) pattern on transbronchial lung biopsies and had fatal outcomes, despite treatment. The remaining four patients presented with less severe symptoms, predominantly consolidations and patchy ground glass and part solid opacities on chest CT, organising pneumonia (OP) or chronic interstitial inflammation histologically, and showed favourable responses to treatment and remission within months. Conclusions: This study highlights two radiological–pathological patterns of ICI-related pneumonitis with different behaviour: (1) severe respiratory symptoms and diffuse GGOs on imaging correlating with ALI pattern histologically and poor prognosis; and (2) mild respiratory symptoms and consolidations or patchy subsolid opacities on imaging correlating histologically with OP or chronic interstitial inflammation and good outcomes. © 2022 John Wiley & Sons Ltd.
Keywords:	adult; clinical article; controlled study; aged; middle aged; retrospective studies; clinical feature; histopathology; follow up; ipilimumab; computer assisted tomography; inflammation; cohort analysis; tomography, x-ray computed; steroid; pathology; diagnostic imaging; retrospective study; dyspnea; pneumonia; lung; bladder carcinoma; lung biopsy; artificial ventilation; respiratory failure; fatality; transbronchial biopsy; ground glass opacity; organizing pneumonia; acute lung injury; diffuse alveolar damage; immune checkpoint inhibitor; nivolumab; humans; human; male; female; article; pembrolizumab; x-ray computed tomography; lung histopathology; immune check-point inhibitor-related pneumonitis; organising pneumonia; dry cough
Journal Title:	Histopathology
Volume:	81
Issue:	6
ISSN:	0309-0167
Publisher:	Wiley Blackwell
Date Published:	2022-12-01
Start Page:	724
End Page:	731
Language:	English
DOI:	10.1111/his.14704
PUBMED:	35775853
PROVIDER:	scopus
PMCID:	PMC10428658
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85135924533&doi=10.1111%2fhis.14704&partnerID=40&md5=09076cbf1e9ed3e98c2ab9dfa1ea5ee9
Notes:	Article -- Export Date: 1 December 2022 -- Source: Scopus

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