Prognostic value of serum surfactant protein D level prior to transplant for the development of bronchiolitis obliterans syndrome and idiopathic pneumonia syndrome following allogeneic hematopoietic stem cell transplantation

Abstract

Bronchiolitis obliterans syndrome (BOS) and idiopathic pneumonia syndrome (IPS) cause high mortality and impaired survival after allogeneic hematopoietic stem-cell transplantation (allo-HSCT). Early recognition of patients at high risk of developing BOS/IPS may lead to improving the outcome of allo-HSCT. We retrospectively analyzed serum surfactant protein A, D (SP-A, -D) and Kerbs von Lungren 6 Ag (KL-6) levels before allo-HSCT in 56 patients who survived more than 90 days after allo-HSCT and compared values of these serum markers and other transplant factors in BOS/IPS patients with those in non-BOS/IPS patients. Five patients developed BOS and two developed IPS at a median interval of 303 and 117 days (range, 100-452 and 95-153) from transplantation. As a result of univariate analysis, pretransplant serum SP-D levels but not SP-A, KL-6 in BOS/IPS patients were significantly lower than those in non-BOS/ IPS patients (P ¼ 0.03). In multivariate analysis, the patients with lower pretransplant serum SP-D level had a trend toward frequent development of BOS/IPS (P ¼ 0.08). Constitutive serum SP-D level before allo-HSCT may be a useful, noninvasive predictor for the development of BOS/IPS.

An Official American Thoracic Society Research Statement: Noninfectious Lung Injury after Hematopoietic Stem Cell Transplantation: Idiopathic Pneumonia Syndrome

“…Furthermore, transtracheal instillation of human SP-A attenuated the manifestations of IPS in mice (137). In humans, pre-transplant serum levels of SP-D were identified as a risk factor for the development of IPS and bronchiolitis obliterans after allogeneic HSCT (138). The investigators speculate that certain polymorphisms in the human SP-D gene cause subnormal levels of SP-D in the alveoli and serum (139).…”

S-nitrosylation of surfactant protein D as a modulator of pulmonary inflammation

“…have shown that SP-D level in the plasma of ALI/ARDS patients was not significantly different when compared to patients without lung injury [63]. Attempts have been made to correlate serum and BAL SP-D levels with human disease, including community-acquired pneumonia in adults, recurrent bronchitis and asthma in pediatric patients, COPD, and smoking [64–65], as well as suggesting the use of low serum SP-D levels as a biomarker for the development of bronchiolitis obliterans in hematopoietic stem cell transplant recipients [66]. …”

Bronchiolitis obliterans following hematopoietic stem cell transplantation: a clinical update

“…Recent reports also suggest that biochemical and genetic factors may predispose HSCT recipients to BO, and detection of these factors may lead to earlier recognition of these patients. In a recent multivariate analysis of 56 patients, the authors reported that lower pre‐transplant serum surfactant protein D level, which is a hydrophilic glycoprotein secreted by alveolar type II cells and plays a role as a mediator of innate immunity of the lung, had a trend toward frequent development of BO following HSCT (p = 0.08) (42). Another study showed that single nucleotide polymorphism of genes may increase the risk of BO following HSCT.…”