Risk Factor and Clinical Outcome of Bronchiolitis Obliterans Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

PurposeThe development of bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (HSCT) deteriorates patients' quality of life. This study aimed to analyze the prevalence, clinical features, risk factors and prognostic factors of BOS.Materials and MethodsThis retrospective study included patients who underwent allogeneic HSCT from January 2002 to December 2008 and survived for ≥100 days after transplantation.ResultsOf 860 patients who survived for ≥100 days, 36 (4.2%) met the diagnostic criteria. The duration of BOS development after transplantation was 466.00 (284.00–642.75) [median (interquartile range)] days. The risk factor for the development of BOS was peripheral blood as the stem cell source with a hazard ratio (HR) of 2.550 [95% confidence interval (CI): 1.274–5.104, p=0.008]. In multivariate analysis, pretransplant FEV1/FVC (HR: 0.956, 95% CI: 0.921–0.993, p=0.020) and time from HSCT to diagnosis of BOS (HR: 0.997, 95% CI: 0.994–0.999, p=0.009) were independent prognostic factors associated with mortality.ConclusionPeripheral blood as a stem cell source is a risk factor for the development of BOS. A decreased pretransplant FEV1/FVC and shorter duration of time from transplantation to diagnosis of BOS are poor prognostic factors for BOS.

Rapid versus gradual lung function decline in bronchiolitis obliterans syndrome after haematopoietic stem cell transplantation is associated with survival outcome

“…The prevalence of BOS among our cohort of allo‐HSCT patients was 6.5%. This result was similar to that reported in previous studies, which showed the overall prevalence of BOS to be about 5.5% . As a form of GVHD, BOS often coexists with GVHD, affecting other organs, including the skin and mucosa, gastrointestinal tract and liver.…”

“…Complications because of allo‐HSCT, including BOS and GVHD, are associated with high mortality within the first 2 years after HSCT . HSCT recipients with BOS, compared to those without BOS, have been reported to exhibit a worse prognosis, with 2‐year survival rates of about 45% and a 5‐year survival of 13% .…”

“…To our knowledge, this study is the first one to demonstrate that different patterns of lung function decline after BOS diagnosis would be associated with different long‐term lung function and survival outcomes. It has been suggested that impaired pulmonary function within the first 6 months post‐HSCT may reflect temporary functional changes related to peri‐transplant events . In a recent report by Cheng et al ., regarding the lung function results after HSCT in at least two cohorts of subjects recruited from different centres for other clinical studies with variable lung function test surveillance protocol, lung function decline was observed in subjects as early as within the 6 months prior to the diagnosis of BOS .…”

“…Bronchiolitis obliterans syndrome (BOS) is an important pulmonary complication after allogeneic HSCT (allo‐HSCT). BOS is usually regarded as a manifestation of graft versus host disease (GVHD) affecting the lung, reported to occur in 2–3% of allo‐HSCT recipients . Symptomatic BOS impairs quality of life and increases mortality .…”

Bronchiolitis obliterans syndrome ‘endotypes’ in haematopoietic stem cell transplantation

“…Compared to lung transplantation, the relative rarity of BOS; the lack of uniform recommendations for lung function follow‐up; and the complexity of indications, induction regimens and transplant types inherent to the practice of haematopoietic stem cell transplantation add heterogeneity, which may obscure endotypes. Previous authors have identified bacterial colonization of the lower respiratory tract, pre‐transplant airflow limitation and shorter duration of time from transplantation to diagnosis of BOS as poor prognostic factors; however, true endotypes remain elusive. Nevertheless, the experience in lung transplantation suggests that attempting to cluster subtypes of BOS together is a worthwhile endeavour.…”