Managing pulmonary complications in allogeneic hematopoietic stem cell transplantation

Long‐term Follow‐up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics

“…Late-onset, noninfectious pulmonary complications (LONIPCs) among HCT survivors are heterogeneous and contribute to significant morbidity and mortality in this patient population. 39 The most common LONIPCs are bronchiolitis obliterans syndrome (BOS) and cryptogenic organizing pneumonia (COP) and have a cumulative incidence of 20% among allogeneic HCT recipients at 3 years after HCT. 2,11,39 BOS is the most common LONIPC and is also recognized as cGVHD of the lungs.…”

“…39 The most common LONIPCs are bronchiolitis obliterans syndrome (BOS) and cryptogenic organizing pneumonia (COP) and have a cumulative incidence of 20% among allogeneic HCT recipients at 3 years after HCT. 2,11,39 BOS is the most common LONIPC and is also recognized as cGVHD of the lungs. 39 HCT recipients with early BOS are often asymptomatic; symptoms slowly progress from dyspnea on exertion and chronic cough to dyspnea at rest, and finally progressive pulmonary compromise leading to challenges with completing activities of daily life.…”

“…2,11,39 BOS is the most common LONIPC and is also recognized as cGVHD of the lungs. 39 HCT recipients with early BOS are often asymptomatic; symptoms slowly progress from dyspnea on exertion and chronic cough to dyspnea at rest, and finally progressive pulmonary compromise leading to challenges with completing activities of daily life. 40 Diagnosis of BOS usually occurs between 3 months and 2 years after HCT and is often challenging to diagnose, as a definitive diagnosis of bronchiolitis obliterans (BO) is based on the analysis of lung biopsy specimens, which involves a high-risk, invasive procedure.…”

“…40 Diagnosis of BOS usually occurs between 3 months and 2 years after HCT and is often challenging to diagnose, as a definitive diagnosis of bronchiolitis obliterans (BO) is based on the analysis of lung biopsy specimens, which involves a high-risk, invasive procedure. 39 In an effort to mitigate the risk of an invasive procedure, the National Institutes of Health (NIH) consensus guidelines defined BOS as the presence of a new-onset obstructive ventilatory pattern on pulmonary function tests (PFTs). 41 Risk factors for BOS are described in Table 2.…”

“…In addition, screening PFTs are recommended at 3, 6, 12, 18, and 24 months after allogeneic HCT and every 3 months in patients with cGVHD. 11,39 Preventative measures using azithromycin early in the post-HCT period were studied in a randomized, double-blind, placebocontrolled trial, which demonstrated worse airflow decline-free survival and an increase in the risk of hematological relapse in patients receiving azithromycin, resulting in early termination of this study. 42 As BOS is also recognized as cGVHD, treatment involves the use of high-dose corticosteroids, which although provide benefit, often results in significant adverse effects.…”