Prognostic role of FEV₁ for survival in bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation

Abstract

An FEV1 < 30% of predicted at the time of diagnosis is significantly associated with an increased risk of death in patients with BOS after HSCT.

Lung Function Trajectory in Bronchiolitis Obliterans Syndrome after Allogeneic Hematopoietic Cell Transplant

“…FEV 1 was not associated with worse outcomes in analyses by Dudek and colleagues (23) and Bergeron and coworkers (16), the latter of whom used a cutpoint of FEV 1 less than 50% predicted. However, Ahn and colleagues showed that a very severe FEV 1 less than 30% predicted at diagnosis was significantly associated with mortality (17), consistent with what is seen clinically in patients with end-stage disease. While there is some degree of correlation of FVC with FEV 1 , our analysis suggests that FVC is an independent risk factor for mortality, which is consistent with what has recently been observed in lung transplantation (19,35).…”

“…To test the hypothesis that FAM treatment was associated with reduced FEV 1 decline compared with standard treatment, univariate and multivariate linear regression was used. Multivariate analysis was performed to adjust for factors that could potentially affect FEV 1 trajectory, including systemic corticosteroids, which is the firstline treatment for chronic GVHD, and other factors that have previously been associated with poor prognosis, including early onset after hematopoietic cell transplant (15,16) and severity of FEV 1 at diagnosis (15,17,18) and FVC (19) as expressed in tertiles.…”

“…The FVC percent predicted values in tertiles were as follows: greater than 77.5% for the upper tertile, 67-77.5% for the middle tertile, and less than 67% for the lower tertile. FEF 25-75 percent predicted at diagnosis was 17% (IQR,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] for the FAM group and 25% (IQR,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] for the FHCRC cohort.Because FEV 1 is the primary spirometric parameter used in clinical practice to evaluate BOS, subsequent analysis was focused on FEV 1 . For subjects with available PFTs pre-BOS, the FAM and FHCRC cohorts had a similar slope of FEV 1 percent predicted decline to diagnosis.…”

The Importance of A, B, Cs! Airways and Breathing Matter for Survival after Hematopoietic Stem Cell Transplantation

“…As demonstrated in previous studies, the diagnosis of BOS is a risk factor for nonrelapse pulmonary mortality and specifically for pulmonary and infection-related death [4,7,8,13]. An as-yet unanswered question is whether this risk decreases with time.…”

Pulmonary Impairment after Respiratory Viral Infections Is Associated with High Mortality in Allogeneic Hematopoietic Cell Transplant Recipients

“…In allo-HCT recipients RVIs have been associated with bronchiolitis obliterans Biology of Blood and Marrow Transplantation journal homepage: www.bbmt.org syndrome (BOS), a form of graft-versus-host disease (GVHD) of the lung [21,22]. BOS occurs in about 5% of HCT recipients [23], and mortality primarily occurs in patients with the most severe impairments in lung function [24][25][26][27]. Outside of BOS, the association of pulmonary impairment with mortality has not been well studied in allo-HCT recipients.…”