Bronchiolitis obliterans (BO) following allogeneic haematopoietic stem cell transplantation (HSCT) affects peripheral airways. Detection of BO is presently delayed by the low sensitivity of spirometry.We examined the relationship between peripheral airway function and time since HSCT, and compared it with spirometry and clinical indices in 33 clinically stable allogeneic HSCT recipients. The following measurements were performed: lung function, exhaled nitric oxide, forced oscillatory respiratory system resistance and reactance, acinar (Sacin) and conductive airways ventilation heterogeneity and lung clearance index (LCI) measured by multiple breath nitrogen washout. 22 patients underwent repeat visits from which short-term changes were examined.Median time post HSCT was 12 months. Eight patients were clinically diagnosed as having BO. In multivariate analysis, time since HSCT was predicted by Sacin and forced expiratory volume in 1 s % predicted. 20 patients had abnormal Sacin with normal spirometry, whereas none had airflow obstruction with normal Sacin. Sacin and LCI were the only measures to change significantly between two visits, with both worsening. Change in Sacin was the only parameter to correlate with change in chronic graft-versus-host disease grade.In conclusion, peripheral airways ventilation heterogeneity worsens with time after HSCT. Sacin may be more sensitive than spirometry in detecting BO at an early stage, which needs confirmation in a prospective study.

Graft-versus-host disease (GVHD) of the central nervous system is a rare complication following allogeneic haematopoietic stem cell transplant (HSCT). It is a challenging disease process to confirm as biopsies of the involved tissues can be difficult to obtain safely, the clinical presentation can be non-specific and the differential diagnosis includes infection, drug toxicities, metabolic encephalopathy and disease relapse. We report a case of meningeal graft-versus-host disease in a young woman with relapsed acute myeloid leukaemia after a sibling allogeneic HSCT. The GVHD responded to immunosuppression with resolution of the clinical symptoms and radiological findings and has remained quiescent after a second allogeneic HSCT from an unrelated matched donor.

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