Implications of early airflow decline after myeloablative allogeneic stem cell transplantation

Abstract

Summary:The clinical significance of early airflow decline after myeloablative allogeneic hematopoietic SCT is uncertain. We performed a retrospective cohort analysis to determine if airflow decline by day 100 is associated with later development of transplant-related airflow obstruction (AFO) and increased mortality risk. Overall, 750 (40%) patients had airflow decline by day 100. Development of airflow decline by day 100 was associated with an increased risk for AFO at 1 year (relative risk 2.6, 95% confidence interval 2.1-3.1) but not with an increase in mortality risk (hazard ratio (HR) 0.86, P ¼ 0.05). However, patients with the fastest rate of decline between day 100 and 1 year (12.5% per year 724) had the highest mortality risk (HR 3.2, Po0.001). In conclusion, airflow measurements made on day 100 do not predict the rate of airflow decline between day 100 and 1 year, and therefore are not useful as a single measurement for determining mortality risk associated with development of AFO. Closer monitoring of the rate of airflow decline during the first year may facilitate the timely detection and treatment of early airflow decline and prevent the development of fixed AFO and increased mortality risk after hematopoietic stem cell transplant.

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.…”

“…PTCB is an important contributor to this process. Chien et al 14 showed that new-onset airflow obstruction after HSCT is an important predictor of mortality. Our results suggest that treatment with high-dose inhaled corticosteroids may be highly efficacious in this population, while inducing fewer side effects.…”

What we know and mostly do not know about bronchiolitis obliterans syndrome

“…We have observed that B40% of patients have 45% annualized decline in FEV1 at day 100 (ref. 4), and 25% have 45% annualized decline in FEV1 at 1 year, 5 whereas the prevalence of BOS has been estimated at B5.5%. 6 We have also observed that 18% of patients have an FEV1 o80% with an FEV1/forced vital capacity ratio o0.7 before allogeneic HCT.…”

“…We have suggested quarterly monitoring of the FEV1 by spirometry during the first year after HCT. 4 More frequent monitoring of the FEV1 should be started if results suggest airflow decline, and further evaluation to assess airflow obstruction by pulmonary function testing is indicated if new impairment persists or progresses in the absence of infection. Evaluation of symptomatic patients should begin with physical exam and chest X-ray.…”

A retrospective multi-centre study of the effects of allogeneic haematopoietic SCT on pulmonary function

“…Identified risk factors for BO include older age of recipient/donor, pre-transplant lung function abnormalities, female donor for male patients and low levels of IgG. [1][2][3] The proportion of HSCT recipients developing lung GvHD varies from 1 to 40% [1][2][3][4] among studies. More accurate data are required for planning controlled trials of treatments such as azithromycin, which is an effective treatment for BO post lung transplantation.…”