Bronchiolitis Obliterans after Autologous Bone Marrow Transplantation

Paz, Harold L.; Crilley, Pamela; Patchefsky, Arthur S.; Schiffman, Robert L.; Brodsky, I

doi:10.1378/chest.101.3.775

Cited by 84 publications

(63 citation statements)

References 12 publications

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“…[7][8][9] Its aetiology remains unresolved, with potential causes including viral infections, autoimmunity and graft-vs-host disease. 6,9,10 In the four cases described in the present study, we describe a pattern of pleuroparenchymal fibroelastosis following bone marrow transplantation, as diagnosed by CT findings and histopathology. Two of the cases were part of a previous CT report of complications post bone marrow transplantation.…”

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confidence: 71%

Pleuroparenchymal fibroelastosis in patients with pulmonary disease secondary to bone marrow transplantation

et al. 2011

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This study presents four patients who underwent bone marrow transplantation and subsequently developed pleuroparenchymal fibroelastosis, hitherto reported as an idiopathic condition. All presented clinically with pneumothorax and subpleural fibrosis on high-resolution computed tomography. In addition to the expected obliterative bronchiolitis, histopathology showed coexistent subpleural changes, and the relationship of pathology in multiple anatomic compartments in post bone marrow transplantation pulmonary disease is discussed.

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confidence: 71%

Pleuroparenchymal fibroelastosis in patients with pulmonary disease secondary to bone marrow transplantation

et al. 2011

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“…28 Although normal airflow has been reported in histologically proven BO, 13 airflow obstruction is its hallmark. Based on forced expiratory volume in 1 s (FEV1) expressed as percent of baseline, BO is classified into three stages: mild (FEV1 66-80%), moderate (FEV1 51-65%), and severe (FEV1 р50%).…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

“…17,25 The variations in histopathologies, bronchoalveolar lavage (BAL) cell differential, and clinical course suggest a multifactorial pathogenesis. 13,25,26 …”

Section: Pathogenesismentioning

confidence: 99%

Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation

Afessa

Tefferi

2001

Bone Marrow Transplant

275

308

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Summary:Pulmonary complications develop in 30-60% of hematopoietic stem cell transplants (HSCT). The main, late onset, non-infectious complications include Bronchiolitis obliterans (BO), Bronchiolitis obliterans organizing pneumonia (BOOP), and idiopathic pneumonia syndrome (IPS). BO and BOOP occur almost exclusively in allogeneic HSCT, and have 61% and 21% mortality rates, respectively. BOOP responds favorably to corticosteroids. IPS has less than 15% 1-year survival. Bone Marrow Transplantation (2001) 28, 425-434. Keywords: pulmonary complications; Bronchiolitis obliterans; Bronchiolitis obliterans organizing pneumonia; interstitial pneumonia; hematopoietic stem cell transplantation Despite the success in treating otherwise fatal diseases, HSCT is associated with multiple complications. Pulmonary complications develop in 30-60% of HSCT recipients. 1,2 Factors that influence the development of pulmonary complications in HSCT include previous infections, pre-transplant conditioning regimen, current or prior immunosuppressant and radiation treatment, type of stem cell transplant (autologous vs allogeneic), use of prophylactic antibiotics, and time elapsed since transplant. With the use of prophylactic antibiotics, the spectrum of pulmonary complications following HSCT has changed increasingly from infectious to non-infectious etiologies. The times of onset and distinguishing features of the main non-infectious pulmonary complications are shown in Figure 1 and Table 1. This review will focus on the late-onset, non-infectious pulmonary complications in HSCT recipients. An algorithmic approach is outlined in Figure 2. Since most of the treatable pulmonary complications in HSCT recipients are diagnosed non-invasively and by bronchoscopy, we rarely subject our patients to surgical lung biopsy. However, in patients with suspected BOOP and when bronchoscopy is contraindicated or non-diagnostic, we occasionally resort to video-assisted thoracoscopic surgical lung biopsy. Abnormal lung functionRestrictive and obstructive ventilatory defects, and gas transfer abnormalities occur frequently in HSCT recipients. 3,4 In a study of 52 young, asymptomatic HSCT recipients, 38% had abnormalities in pulmonary function tests (PFT): 23% restrictive defect with or without impaired gas transfer and 15% isolated impaired gas transfer. 3 An abnormal pulmonary function test is a risk factor for pulmonary complications. 5-9 However, the role of PFT in identifying HSCT recipients at risk for pulmonary complications needs further investigation. The PFT findings in BO, BOOP, and delayed pulmonary toxicity syndrome are listed in Table 2. Bronchiolitis obliterans (BO)GVHD is a frequent complication of allogeneic HSCT. 10 The pulmonary morphological manifestations of GVHD include diffuse alveolar damage, lymphocytic bronchitis/ bronchiolitis with interstitial pneumonitis, BOOP, and BO. 11 BO is a nonspecific inflammatory injury affecting

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“…These measures could be of great impor- (10% in our series). Although some studies have suggested an infectious agent or micro-aspiration mechanism, 18,19 immunological damage is accepted as the etiological basis.…”

Section: Response Criteriamentioning

confidence: 99%

Long-term follow-up of immunosuppressive treatment for obstructive airways disease after allogeneic bone marrow transplantation

Sánchez

Torres

Serrano

et al. 1997

Bone Marrow Transplant

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Summary:(CGVHD), older age, use of methotrexate (MTX) as prophylaxis for GVHD and low levels of serum immunoglobulin (Ig). 5,6 Classical management of these patients To describe clinical outcome with first line immunosuppression therapy for obstructive airways disease includes bronchodilators (aerosolised ␤-agonists), antiinfectious prophylaxis, Igs replacement, and immunosup-(OAD) after allogeneic BMT, we have retrospectively examined 20 long-term survivors affected by OAD. All pressive agents such as prednisone (PRD), AZT or CsA. Despite aggressive treatment, the mortality rate is over 50% patients had normal pulmonary function test (PFTs) before BMT. OAD was defined as FEV1 less than 80%, (ranging from 21 to 100%), in most published series, 7,8 significantly higher than in comparable cohorts without OAD. FER less than 80%, maximum midexpiratory flow rate of 50% vital capacity (MMFR) less than 65%, orComplexity in the management of these patients is due largely to the lack of standardised approaches and the fact residual volume greater than 120. Prednisone (n = 4), CsA (n = 8) and azathioprine (n = 8) have been used as that the effectiveness of specific regimens has never been established. Furthermore, there are no well-defined first-line immunosuppression agents. Mean follow-up was 65 months (range 15-142). We identified three catresponse criteria and consequently the optimal duration of immunosuppression therapy remains uncertain. egories of patients according to response to treatment: complete (n = 6, 30%), partial (n = 6, 30%) or noIn this retrospective study we analysed 20 patients affected by OAD from 275 patients who underwent allogeneic response (n = 8, 40%). Age, FEV1, time of onset after BMT, Karnofsky index or immunosuppression modality BMT at a single institution over a 12 year period and had had long-term follow-up. Presence of risk factors was do not seem to be related to subsequent response. However, patients with low values of MMFR and high values assessed. The aims of the study were to analyse the patterns of pulmonary function evolution over the treatment period, of RV at the beginning of therapy are likely to show poor response. In the complete response group, normaland evaluate the role of different immunosuppression regimens in clinical outcome. isation of PFTs is achieved within the first months of treatment (median 6 months ranging from 3 to 9 months), suggesting that prolonged therapy is not advantageous and could increase morbidity and morPatients and methods tality if there are no other signs of CGVHD. Keywords: obstructive airways; immunosuppression; Patients BMT Between May 1981 and July 1995, allogeneic bone marrow transplantation was performed on 275 patients at the University Hospital Reina Sofia. Of these patients 225 who Respiratory complications after BMT, both early (occurring survived more than 3 months after BMT and were at risk within the first 3 months) and late, affect 40-60% of of developing OAD were included in this study. Patient patients and are the major cause of mo...

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Bronchiolitis Obliterans after Autologous Bone Marrow Transplantation

Cited by 84 publications

References 12 publications

Pleuroparenchymal fibroelastosis in patients with pulmonary disease secondary to bone marrow transplantation

Pleuroparenchymal fibroelastosis in patients with pulmonary disease secondary to bone marrow transplantation

Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation

Long-term follow-up of immunosuppressive treatment for obstructive airways disease after allogeneic bone marrow transplantation

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