Airflow Obstruction after Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Despite advances in the management of myeloablative allogeneic hematopoietic stem cell transplants, airflow obstruction (AFO) remains a significant complication. We conducted a 12-year study to examine the recent epidemiology of AFO and its associated mortality. Using the rate of percent predicted FEV1 decline after transplant, we defined AFO as a more than 5% per year decline in percent predicted FEV1 with the lowest post-transplant FEV1/FVC ratio less than 0.8. New obstruction was more frequent than previous estimates (26% overall, 32% among patients with chronic graft-versus-host disease [GVHD]) and was significantly associated with older age at transplant, lower pretransplant FEV1/FVC ratio, history of both acute and chronic GVHD, and respiratory viral infection within the first 100 days after transplant. AFO was associated with significant attributable mortality rates of 9% at 3 years, 12% at 5 years, and 18% at 10 years after transplant, which were much higher for the subpopulation of patients with chronic GVHD (22% at 3 years, 27% at 5 years, and 40% at 10 years). These results suggest that the incidence of AFO may have been underestimated previously, and its presence significantly increases the mortality of long-term survivors of myeloablative allogeneic hematopoietic stem cell transplant patients.

Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation

“…In agreement with other previously published studies, 2,4,6,14,15 we found that nearly all patients who developed new-onset airflow obstruction after HSCT had chronic GVHD, suggesting that PTCB is a pulmonary manifestation of GVHD. Low levels of serum IgG and history of viral infections were also associated with this disease.…”

“…2,3 Post transplantation constrictive bronchiolitis (PTCB) is the most common pulmonary complication among long-term survivors that may lead to progressive respiratory insufficiency and even death. [2][3][4][5][6] Due to the lack of uniform diagnostic criteria, the reported incidence of PTCB varies from 10 to 26%. 4 The most commonly identified risk factors are chronic GVHD, older age, viral respiratory infections during the first 100 days after transplantation, airflow limitation before transplantation and low level of serum IgG.…”

“…[2][3][4][5][6] Due to the lack of uniform diagnostic criteria, the reported incidence of PTCB varies from 10 to 26%. 4 The most commonly identified risk factors are chronic GVHD, older age, viral respiratory infections during the first 100 days after transplantation, airflow limitation before transplantation and low level of serum IgG. 4,7 The pathophysiology of PTCB is not well understood, however, it is generally accepted that PTCB is a pulmonary manifestation of chronic GVHD.…”

Outcome and treatment of late-onset noninfectious pulmonary complications after allogeneic haematopoietic SCT

“…These facts limited the standardization of Palmas's criteria and individual reports of LONIPCs use different classification criteria. 8,9,12 Recently, several studies have revealed many risk factors that are associated with the onset of LONIPCs, including cGVHD, 9,[12][13][14][15][16][17][18][19] donor and recipient age, 13 baseline pulmonary function, 13 use of TBI, 20 and so on. There is a general agreement that cGVHD is the most strongly associated risk factor.…”

“…There is a general agreement that cGVHD is the most strongly associated risk factor. 9,[12][13][14][15][16][17][18][19] Although patients with LONIPCs have high nonrelapse mortality (NRM) rates, 9,12 they experience low relapse rates of the underlying disease presumably because high concomitant rates of cGVHD exert a graft-vs-tumor effect. 9 Thus, it remains unknown whether the onset of LONIPCs has an impact on OS or relapse-free survival as a consequence of these contradictory factors.…”