Pulmonary Rehabilitation for Bronchiolitis Obliterans Syndrome after Hematopoietic Stem Cell Transplantation

Abstract

Bronchiolitis obliterans syndrome (BOS) is a progressive, insidious lung disease affecting allogeneic hematopoietic stem cell transplant (HSCT) recipients. Unfortunately, there is no standardized approach for treatment of BOS in post HSCT patients. Pulmonary rehabilitation is a standard treatment in emphysema, an irreversible obstructive lung disease secondary to tobacco abuse. The National Emphysema Treatment Trial (NETT) demonstrated improved exercise tolerance, decrease dyspnea, and increase of quality of life in patients with severe emphysema after pulmonary rehabilitation. We hypothesized that pulmonary rehabilitation may benefit patients with BOS. Patients with BOS were identified retrospectively from January 2005 to the present. Patients who enrolled in pulmonary rehabilitation were included in the study. We obtained summaries via chart review of each patient’s progress after pulmonary rehabilitation enrollment from their respective rehabilitation centers. Six minute walk distances, spirometry, and pulmonary symptoms were compared before and after the completion of pulmonary rehabilitation. We identified 11 patients with BOS documented from their pulmonologist’s clinical notes that were enrolled into pulmonary rehabilitation. Ten of the 11 patients completed pulmonary rehabilitation. All patients had improvement in their 6 minute walk distances after the completion of pulmonary rehabilitation with an average improvement in distance of 307 feet (p value = 0.005). Six of the 10 patients completed a Short Form-36 questionnaires prior to and after rehab. There was a significant improvement in the physical functioning score (p value =0.029). Pulmonary rehabilitation appears to improve 6 minute walk distance, subjective symptoms of dyspnea and exercise tolerance in patients with BOS. This may be an important adjunctive therapy for a debilitating disease with limited treatment options.

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report

“…Combination therapy with fluticasone, azithromycin, and montelukast is tolerable and may benefit newly diagnosed BOS. Pulmonary rehabilitation programs may be beneficial in BOS [75], as has been shown in chronic obstructive pulmonary disease. Standard 6-minute walk tests [76] help to better characterize physical performance and identify patients who need supplemental oxygen based on having pulse oximeter oxygen saturation (SpO 2 ) <87% while breathing room air.…”

Comprehensive pulmonary rehabilitation in patients with bronchiolitis obliterans syndrome: A case series

“…Most PR strategies and research have focused on patients with chronic obstructive pulmonary disease (COPD). However, more recent studies have demonstrated the effectiveness of PR for other chronic respiratory diseases [ 4 , 5 ], although the effect of PR in patients with BOS has not been extensively studied [ 1 ].…”

“…Bronchiolitis obliterans syndrome (BOS) is the most serious form of pulmonary graft-versus-host disease (GVHD) and is clinically characterized by obstructive airflow disease and pathologically by circumferential fibrous scar tissue targeting the small airways [ 1 , 2 ]. The prevalence of BOS is estimated to be 2–3% in allogenic hematopoietic stem cell transplantation (Allo-HSCT) recipients and 6% in chronic GVHD patients [ 2 ].…”

Sport- und physiotherapeutische Maßnahmen zur Behandlung der chronischen Graft-versus-Host-Krankheit

“…Das durchge führte kombinierte Kraft und Ausdauertraining führte zu einer si gnifikanten Verbesserung der Gehstrecke und der physischen Funk tionsfähigkeit. Die Spirometrieparameter (FEV1, FVC) veränderten sich hingegen nicht [20].…”