Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

Abstract

Bronchiolitis obliterans (BO) following allogeneic haematopoietic SCT (HSCT) is a serious complication affecting 1.7-26% of the patients, with a reported mortality rate of 21-100%. It is considered a manifestation of chronic graftversus-host disease, but our knowledge of aetiology and pathogenesis is still limited. Diagnostic criteria are being developed, and will allow more uniform and comparable research activities between centres. At present, no randomised controlled trials have been completed that could demonstrate an effective treatment. Steroids in combination with other immunosuppressive drugs still constitute the backbone of the treatment strategy, and results from our and other centres suggest that monthly infusions of high-dose pulse i.v. methylprednisolone (HDPM) might stabilise the disease and hinder progression. This article provides an overview of the current evidence regarding treatment options for BO and presents the treatment results with HDPM in a paediatric national HSCT-cohort.

Pleuroparenchymal Fibroelastosis as a Series of Airway Complications Associated with Chronic Graft-versus-host Disease following Allogeneic Bone Marrow Transplantation

“…Histopathologically, BO is characterized by peribronchiolar fibrosis that leads to luminal narrowing and eventual obliteration (5). In previous reports of secondary PPFE, obliteration and fibroblastic plugging have been recognized in the terminal bronchioles and alveolar ducts (8).…”

“…Recently, other rare pulmonary complications that have led to the development of small chronic pneumothoraces or pleuroparenchymal fibroelastosis (PPFE) in patients with BMT have been reported (7,8). Although BO may be related to cGVHD, the pathophysiological role of cGVHD in other pulmonary complications is not fully understood (3,5).…”

“…Bronchiolitis obliterans (BO) is the most common form of late-onset, noninfectious pulmonary complications (4)(5)(6). Recently, other rare pulmonary complications that have led to the development of small chronic pneumothoraces or pleuroparenchymal fibroelastosis (PPFE) in patients with BMT have been reported (7,8).…”

Late effects in children who underwent hematopoietic stem cell transplantation (review)

“…С другой стороны, большое влияние на легкие может оказать хроническая РТПХ, которая проявляется в виде облитерирующего бронхиолита и зачастую крайне трудно поддается лечению [48], в связи с чем требуется постоянно контролировать функцию легких для скорейшей диагностики возмож-ных осложнений.…”

Stable long-term pulmonary function after fludarabine, antithymocyte globulin and i.v. BU for reduced-intensity conditioning allogeneic SCT

“…6 Also, cGHVD has been identified as a risk factor for late-onset non-infectious pulmonary complications and in particular BOS. [7][8][9][10] On the other hand, cGVHD is usually significantly reduced in patients receiving in vivo T-cell depletion by administration of antithymocyte globulins (ATG). 11 However, the onset of long-term pulmonary complications in patients receiving an ATG-based RIC regimen, without TBI, has not yet been investigated.…”