Chest health surveillance utility in the early detection of bronchiolitis obliterans syndrome in children after allo-SCT

Abstract

To prospectively assess whether periodic chest health surveillance is beneficial for the early detection of bronchiolitis obliterans syndrome (BOS) in children after allo-SCT. Children up to 18 years of age receiving allo-SCT from September 2009 to September 2011 were included. Surveillance consisted of the following: a 7-item respiratory system questionnaire of cough, wheeze and shortness of breath; focused physical examination; and pulmonary function test (PFT) conducted before SCT and at 1, 3, 6, 9, 12, 18 and 24 months after SCT. Thirty-nine patients were enrolled. Five children developed BOS at a median time of 192 days (range 94-282). Positive response comparisons between the BOS group vs the non-BOS group were NS for history questionnaire (P ¼ 0.2), heart rate (P ¼ 0.3), respiratory rate (P ¼ 0.3) and oxygen saturation monitoring (P ¼ 0.8). Differences between the two groups for chest auscultation and PFT were statistically significant (P ¼ 0.03 and P ¼ 0.01, respectively). However, chest auscultation in the BOS group was only positive after BOS diagnosis. PFT reduction was evident in the asymptomatic phase (BOS group 33%; non-BOS group 4.5%, P ¼ 0.01). Changes in PFT, but not history/physical examination, allow the early detection of BOS in children after SCT. Our study is limited by the small sample size.

NHANES III equations enhance early detection and mortality prediction of bronchiolitis obliterans syndrome after hematopoietic SCT

“…Ways to improve diagnostic sensitivity and specificity for BOS after HSCT could thus be important for improving outcomes. Recent data have revealed that decline in PFT parameters was the best way to identify children at risk for BOS 27 and support prior publications in adults. 1 The importance of FEV1 in the characterization of the severity of BOS is long established.…”

Small airways dysfunction in long‐term survivors of pediatric stem cell transplantation

“…The clinical equivalent, BO Syndrome (BOS), requires at least one distinctive extra‐pulmonary sign for cGvHD diagnosis, in addition to a forced expiratory volume in 1 sec (FEV 1 ) < 75%, FEV 1 /forced vital capacity (FVC)‐ratio < 0.7, residual volume (RV) > 120%, and signs of air‐trapping, bronchiectasis, or peribronchial thickening by high resolution computed tomography (HRCT), not attributable to infection . Typical symptoms of BO and BOS include cough, dyspnea, and wheezing, but patients may be relatively asymptomatic in the early stages …”

Serum Krebs Von Den Lungen-6 as a Biomarker for Early Detection of Bronchiolitis Obliterans Syndrome in Children Undergoing Allogeneic Stem Cell Transplantation

“…Reduction in PFTs is the mainstay for BOS diagnosis; however, a significant reduction occurs while the patient is completely asymptomatic, and by the time the diagnosis is made based on PFT reduction, significant lung damage has already occurred [29]. Furthermore, young children are uncooperative or unable to perform effective PFTs.…”