Peripheral Airway Function Declines Following Allogeneic Transplantation And Is Associated With The Development Of Chronic GVHD

Multiple breath washout and oscillometry after allogenic HSCT: a scoping review

“…Take-home message: there is a consistent suggestion within both paediatric and adult studies that cross-sectional MBW values are more frequently abnormal than spirometry post-HSCT, occurring in all Baseline: FEV 1 abnormal in 13% and D LCO in 70% 1-year follow-up: FEV 1 and FVC at baseline were associated with FEV 1 and FVC at 12 months FEV 1 at 3 months and FVC at all time points were lower than at baseline GVHD: FEV 1 significantly lower in GVHD than non-GVHD subjects BOS/BO: all patients with abnormal FEV 1 at 3 months developed BOS Baseline: LCI abnormal in 48% 1-year follow-up: LCI at baseline and 3 months was not associated with LCI at 12 months; LCI did not change over time GVHD: LCI was significantly higher in GVHD than non-GVHD subjects BOS/BO: abnormal LCI at baseline and 3 months was not associated with development of BOS; absolute median (range) LCI in BOS: 7.9 (6.4-11.8) at baseline, 7.9 (7.4-14.0) at 3 months, 8.4 (6.3-13.0) at 6 months, 8. 4 NA There was evidence of worsened S acin and S cond as compared to healthy controls regardless of the presence of chronic GVHD in other organ systems in subjects without BO In subjects with BO S acin was 551% (SD 360) and worse than in controls (p<0.001); S acin with a 321% cut-off had an 89% sensitivity and 93% specificity in identifying patients with BO LAHZAMI et al [48,88] and PECHEY et al [89] Initial testing (mean±SD or median (range)): FEV 1 was 87±20% pred, FEV 1 /FVC 80 (45-89) FEV 1 was independently associated with time post-HSCT Follow-up: no significant change in spirometry outcomes Initial testing (mean±SD or median (range)): LCI 12.1 (8.0-22.2), S acin 0.24 (0.08-1.72) and S cond 0.07±0.03; S acin was independently associated with time post-HSCT; S acin was correlated with chronic GVHD grade Follow-up: LCI significantly increased from mean±SD 11.6±2.5 to 13.5±3.5 and S acin increased from median 0.28 (range: 0.06-0.69) to 0.41 (0.08-1.07); only change in S acin correlated with change in GVHD grade HTUN et al [50,90] Baseline: mean±SD FEV 1 101±15% pred, FEV nine studies that evaluated this. However, rates of abnormality varied across studies.…”

“…Changes over time need to be interpreted within the context of known variability. Specific to this setting, RUTTING et al [51] cGHVD was associated with significant deterioration in FEV 1 and FEF 25-75 compared to those without cGVHD At 3 years post-HSCT, BOS 0p subjects (n=8) had FEV 1 worse than subjects unaffected by BOS 0p/BOS that approached significance cGVHD: significant increases in X rs at 5 Hz, AX and F res as compared to subjects without cGVHD BOS was associated with significant abnormality in X rs at 5 Hz, AX and F res ; oscillometry abnormality was not detected prior to BOS diagnosis BOS 0p (n=8) subjects at 3 years post-HSCT significantly worse X rs at 5 Hz as compared to subjects unaffected by BOS 0p/BOS and this approached significance for F res Adult subjects DE GIACOMI et al [45,86,87] NA Subjects with BO: mean±SD X rs at 5 Hz was −1.84±2.26 and significantly worse than in controls (p=0.023) BLIN et al [52] NA X rs at 5 Hz, AX, F res and R5-R20 were significantly worsened at time of BOS diagnosis as compared to first test; these indices did not change significantly earlier than FEV 1 LAHZAMI et al [48,88] and PECHEY et al [89] Initial testing (mean±SD or median (range)): FEV 1 was 87±20% pred, FEV 1 /FVC 80 ; FEV 1 was independently associated with time post-HSCT Follow-up: no significant change in spirometry outcomes Mean±SD or median (range): R rs at 6 Hz 118±31% pred and X rs at 6 Hz 153 (9-997)% pred Follow-up: median (range) R rs was 103% pred (73-259) and X rs was 172% pred There was no significant change from initial testing BARISIONE et al 2012 [53,91] Baseline: spirometry and oscillometry were within normal range; mean±SD FEV 1 was 3.67±0.74 L, FEV 1 /FVC was 0.81±0.06 Follow-up: there was no significant change in FEV 1 or FEV 1 /FVC, which were mean±SD 3.54±0.75 L and mean±SD 0.81±0.15, respectively Baseline: oscillometry was within normal range, X rs at 5 Hz was −0.50±0.29 Follow-up: X rs at 5 Hz became less negative (p=0.01) and was mean±SD −0.43±0.28 SCHOEFFEL et al [49,59] Baseline: mean±SD FEV 1 was 105±13% pred, FEV 1 /FVC was normal Follow-up: FVC declined Baseline: R rs and X rs at 6 Hz were normal in 91% Follow-up: no changes in R rs and X rs at 6 Hz BOS subjects: R rs and X rs at 6 Hz were all abnormal at time of BOS diagnosis; respiratory function at the visit prior to diagnosis was not different from baseline RUTTING et al [51,92] Mean±SD FEV 1 /FVC ratio was 0.78±0.07…”