Bronchiolitis Obliterans After Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

With improvements in supportive care, both long-term survival following allogeneic hematopoietic stem cell transplantations (HSCTs) and the indications for this procedure have increased. As a result, the number of patients living with long-term toxic effects due to HSCT has increased. A once rare condition of the donor immune cells attacking healthy host tissues, termed chronic graftvs-host disease, has become a more common phenomenon. When chronic graftvs-host disease affects the lung tissue, bronchiolitis obliterans syndrome ensues. Recent data suggest that bronchiolitis obliterans syndrome may affect up to 6% of HSCT recipients and dramatically alters

Identification of risk factors for bronchiolitis obliterans syndrome after reduced toxicity conditioning before hematopoietic cell transplantation

“…These findings might help us to identify a risk population after reduced-intensity conditioning and lead to personalized measures for GVHD prophylaxis and therapy as proposed. 9,34 …”

“…8 These diagnostic criteria have been recently evaluated and revised. 9 The incidence of BOS in several other publications ranged from 8.3% to 26%. 3,5,10,11 These differences may be attributed to differences in the definition of BOS, conditioning protocol's toxicity, GVHD prophylaxis, hematopoietic stem cell source and HLA compatibility.…”

Extracorporeal photopheresis as a new supportive therapy for bronchiolitis obliterans syndrome after allogeneic stem cell transplantation

“…At early stages, patients can be asymptomatic; later in the course of disease, respiratory infections or chest constriction due to advanced sclerotic GvHD or intrapulmonary processes may hinder the correct diagnosis. 4,5 Current treatment of BOS (macrolides, change or increase in immunosuppression-mainly steroids-and inhaled therapy 6 ) still remains unsatisfactory with high mortality rates. 7 Recently, extracorporeal photopheresis (ECP) has been reported as a promising option for treatment of BOS in two case series.…”

Imatinib for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation

“…1 BO is a major cause of morbidity and mortality following allo-SCT, with an overall survival rate of only 13% at 5 years. 2,3 As is often the case with a fibrotic disorder, BO responds poorly to corticosteroids or immunosuppressants once it develops. Therefore, new treatment options are urgently needed to inhibit the progression of BO.…”