Exhaled nitric oxide and pulmonary complications after paediatric stem cell transplantation

Fazekas, Tamás; Eickhoff, Philipp; Lawitschka, Anita; Knotek, Bobbie; Pötschger, Ulrike; Peters, Christina

doi:10.1007/s00431-012-1692-x

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Exhaled nitric oxide is a measure of pulmonary inflammation [12], and the inflammatory response in general probably evolved to help host organisms fight infection [13]. A recent study in 30 children with a mean age of 12 years suggests that higher exhaled nitric oxide is associated with pulmonary complications (predominantly infections) 28 days after receiving a HSCT [14], demonstrating that this biological response is active in the early period after receiving a HSCT. Hence, we cautiously speculate that the inverse association between change in pulmonary inflammation and mortality observed in our dataset, if a true phenomenon, may be a consequence of an impaired ability to generate an inflammatory response, which may then result in increased susceptibility to infections in this patient group.…”

Section: Discussionmentioning

confidence: 99%

The acute impact of a hematopoietic allograft on lung function and inflammation: a prospective observational study

et al. 2013

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BackgroundNo studies have investigated the immediate impact of receiving an allogeneic hematopoietic stem cell transplant (HSCT) on pulmonary inflammation or lung function.MethodsUsing a prospective study design, we quantified the changes in these outcome measures in eligible adult individuals in the first six months after receiving an allogeneic hematopoietic stem cell transplant.ResultsBetween January 2007 and December 2008, 72 patients were eligible to participate in the cohort, and of these 68 (94%) were included in the study. Compared to baseline, pulmonary inflammation as measured by exhaled nitric oxide increased after receiving a HSCT with the largest increment seen at three months (+6.0ppb, 95%CI: +0.4 to +11.5), and this was sustained at six months. Percent predicted forced expiratory volume in one second decreased over the same period, with the largest decrease observed at six weeks (−5.9%, 95% CI: -8.9 to −2.9), and this was also sustained over a six month period. Similar associations were observed for FVC. A larger increase in exhaled nitric oxide from baseline at six weeks and three months may be associated with decreased mortality (p=0.06, p=0.04 respectively).ConclusionOur data demonstrate that recipients of an allogeneic HSCT experience an increase in biomarkers of pulmonary inflammation and a decrease in lung function in the first six months after the procedure. If independently validated in other study populations, these observations could have potential as a prognostic biomarker for this patient group.

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Section: Discussionmentioning

confidence: 99%

The acute impact of a hematopoietic allograft on lung function and inflammation: a prospective observational study

et al. 2013

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“…However, FeNO unfortunately failed to demonstrate such a predictive value. Fazekas et al [ 20 ] evaluated the correlation of FeNO and pulmonary complications in 30 pediatric HSCT patients. They measured FeNO 10 days before HSCT and at day 0, day 28, and day 60 of HSCT.…”

Section: Discussionmentioning

confidence: 99%

Is It Possible to Predict Pulmonary Complications and Mortality in Hematopoietic Stem Cell Transplantation Recipients from Pre-Transplantation Exhaled Nitric Oxide Levels?

Köktürk¹,

Yıldırım

Aydoğdu³

et al. 2016

Tjh

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Objective:Chemo/radiotherapy-induced free oxygen radicals and reactive oxygen derivatives contribute to the development of early and late transplantation-related pulmonary and extra-pulmonary complications in hematopoietic stem cell transplantation (HSCT) recipients. It has been proposed that an increase in fractional exhaled nitric oxide (FeNO) level indicates oxidative stress and inflammation in the airways. The aim of this prospective study is to evaluate the pre-transplantation FeNO levels in HSCT patients and to search for its role in predicting post-transplantation pulmonary complications and mortality.Materials and Methods:HSCT patients were included in the study prospectively between October 2009 and July 2011. Pre-transplantation FeNO levels were measured with a NIOX MINO® device prior to conditioning regimens. All patients were monitored prospectively for post-transplantation pulmonary complications with medical history, physical examination, chest X-ray, and pulmonary function tests.Results:A total of 56 patients (33 autologous, 23 allogeneic) with mean age of 45±13 years were included in the study, among whom 40 (71%) were male. Pre-transplantation FeNO level of the whole study group was found to be 24±13 (mean ± standard deviation) parts per billion (ppb). The FeNO level in allogeneic HSCT recipients was 19±6 ppb while it was 27±15 ppb in autologous HSCT recipients (p=0.042). No significant correlation was found between the pre-transplantation chemotherapy and radiotherapy protocols and baseline FeNO levels (p>0.05). Post-transplantation pulmonary toxicity was identified in 12 (21%) patients and no significant relationship was found between baseline FeNO levels and pulmonary toxicity. The survival rate of the whole study group for 1 year after transplantation was 70%. No significant relationship was identified between baseline FeNO values and survival (FeNO 19±7 ppb in patients who died and 26±15 ppb in the survivors; p=0.114).Conclusion:Pre-transplantation FeNO measurement does not seem to have a role in predicting post-transplantation pulmonary complications and mortality.

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“…Nasal NO is significantly lower in pediatric lung transplant recipients when compared to other solid-organ recipients or healthy controls, and was negatively correlated with tacrolimus levels [175]. Higher FE NO was also observed in children with pulmonary complications after hematopoietic stem cell transplantation [176].…”

Section: Transplantationmentioning

confidence: 95%

Fractional Exhaled Nitric Oxide: Indications and Interpretation

Kim

Kercsmar

Davis

2014

Diagnostic Tests in Pediatric Pulmonology

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Exhaled nitric oxide (NO) is a marker for eosinophilic airway inflammation. The correlations between fraction of exhaled NO (FE NO ) and eosinophils in blood, sputum, bronchoalveolar lavage, and mucosal biopsies of the airway have been well studied. A quantitative, noninvasive, and simple methodology has been developed to determine how best to assess FE NO as a measure of airway inflammation. FE NO measurement has been standardized by the American Thoracic Society/ European Respiratory Society (Am J Respir Crit Care Med 171(8): [912][913][914][915][916][917][918][919][920][921][922][923][924][925][926][927][928][929][930] 2005). The gold standard for measuring FE NO is the single-breath online method, which can be performed in young children from the age of 4-5 years. A chemiluminescencebased analyzer or a portable analyzer using an electrochemical sensor can be used to measure FE NO . Many studies have shown that FE NO has potential diagnostic and therapeutic roles in various respiratory diseases, particularly asthma. In asthma, FE NO is useful to diagnose and monitor eosinophilic airway inflammation, and predict steroid responsiveness. It also can be helpful in supporting the diagnosis of asthma and in guiding adjustment of anti-inflammatory medication. ATS Clinical Practice Guidelines have been published for interpretation and clinical applicability of FE NO (Dweik et al., 184(5):602-615, 2011). FE NO can provide additional information on underlying airway inflammation, and is complementary to respiratory symptoms, lung function tests, and bronchial provocation tests for asthma and other respiratory diseases in the clinical setting.

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Exhaled nitric oxide and pulmonary complications after paediatric stem cell transplantation

Abstract: Children with pulmonary complications after day +28 have higher mean FeNO levels 28 days after HSCT than children without later pulmonary complications. Therefore, FeNO could be an important diagnostic tool for hyperinflammatory response in bronchial epithelium after paediatric HSCT.

Cited by 5 publications

References 30 publications

The acute impact of a hematopoietic allograft on lung function and inflammation: a prospective observational study

The acute impact of a hematopoietic allograft on lung function and inflammation: a prospective observational study

Is It Possible to Predict Pulmonary Complications and Mortality in Hematopoietic Stem Cell Transplantation Recipients from Pre-Transplantation Exhaled Nitric Oxide Levels?

Fractional Exhaled Nitric Oxide: Indications and Interpretation

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