Value of Screening Spirometry for Early Diagnosis of Bronchiolitis Obliterans Syndrome in Children After Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Bronchiolitis obliterans syndrome (BOS) is a chronic graft-versus-host disease that occurs in the lungs after hematopoietic stem cell transplantation (HSCT). Serial screening pulmonary function test (PFT) is recommended after transplantation for early diagnosis of BOS. However, little is known about the value or the optimum methods of serial PFT in this context. One hundred and 10 consecutive patients of 6 to 17 years of age at the time of transplantation who underwent allogeneic HSCT were recruited for this study. Screening PFTs were performed 1 week before transplantation and 3, 6, 9, and 12 months after transplantation. When findings of obstructive lung disease were found on PFT, chest high-resolution computed tomography was performed. Of the 110 patients, 5 (4.5%) developed BOS. Of the 5 patients who developed BOS, 2 patients were diagnosed early by screening PFT. However, screening PFT did not allow for early diagnosis of BOS in the other 3 patients because BOS developed after 12 months of transplantation, which is beyond the PFT screening period. In conclusion, trimonthly PFTs performed through 12 months after transplantation in patients who underwent allogeneic HSCT helped in the early diagnosis of BOS; however, there are some limitations to this screening protocol. Future studies will aid in the development of a new screening protocol that can subsequently be evaluated.

Imatinib melylate as second‐line treatment of bronchiolitis obliterans after allogenic hematopoietic stem cell transplantation in children

“…The evaluation of PFT results together with radiological signs (on CT scan) and the clinical picture using the NIH criteria is considered a more appropriate diagnostic approach for assessing BO. In particular, the precocity of BO diagnosis and regular monitoring of patients with BO have a positive impact on the outcome of this complication 37 . The prognosis of BO may be improved by providing the most care by way of supportive therapies, such as the optimization of nutrition, rehabilitation therapies, and exclusion of gastroesophageal reflux disease, which may be associated with the development and progression of BO.…”

“…In particular, the precocity of BO diagnosis and regular monitoring of patients with BO have a positive impact on the outcome of this complication. 37 The prognosis of BO may be improved by providing In our experience in the pediatric population, the use of IM in children with BO dramatically changes the prognosis of this complication. The overall response (including CR and PR) to IM was 76.9%, which is higher than that reported in the literature.…”

Lung clearance index for early detection of pulmonary complications after allo‐HSCT in children

“…Regular screening by spirometry every 3 months may reveal subclinical BO changes, however, BO has a predilection for the small membranous and respiratory bronchioles . These small airways constitute 95% of the total lung volume, but contribute only 10% to 20% to the total airway flow‐restrictive pressure loss in healthy lungs .…”

Identification of pediatric bronchiolitis obliterans syndrome posthematopoietic stem cell transplantation; surveillance is the key

“…The authors declare that there are no conflict of interests. Shivanthan Shanthikumar FRACP 1,2,3 Liam Welsh PhD 1,2 Nicole Westrupp MS 1,2 Theresa Cole PhD 3,4 Katherine B. Frayman FRACP 1,2,3…”