Rapid versus gradual lung function decline in bronchiolitis obliterans syndrome after haematopoietic stem cell transplantation is associated with survival outcome

Abstract

Background and objective: Bronchiolitis obliterans syndrome (BOS) after haematopoietic stem cell transplantation (HSCT) presents with lung function decline. The pattern of lung function decline after BOS diagnosis could impact prognostication of BOS as a complication after HSCT. The aim of this study was to assess the impact of lung function decline on overall survival (OS) in BOS subjects. Methods: Subjects with BOS were compared to those without BOS and matched for age, gender, primary diagnoses, conditioning regimes and chronic graft versus host disease. Lung function tests at baseline, at BOS diagnosis and every 3 months after HSCT were evaluated. Results: Of the 1461 subjects undergoing allogeneic HSCT (allo-HSCT) between 1998 and 2015, 95 (6.5%) were diagnosed with BOS. A total of 159 matched HSCT recipients without BOS were identified. A 25% decline in FEV 1 within the first 3 months after BOS diagnosis would separate BOS subjects into a subgroup with initial rapid decline and another subgroup with initial gradual decline in lung function. The rapid decline group showed lower subsequent lung function parameters and significantly worse OS compared to the gradual decline group (P = 0.013). Conclusion: Post-HSCT BOS subjects with initial rapid lung function decline within 3 months after BOS diagnosis will have significantly poorer lung function and worse OS compared to those with initial gradual decline in lung function after BOS diagnosis. HSCT BOS patients with rapid initial decline in lung function warrant closer monitoring for the development of other post-HSCT complications that could affect their survival.

Total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation: a single‐center experience and review of literature

“…The rate of FEV 1 ‐decline in BOS is variable, yet patients presenting with a FEV 1 (or FVC)‐decline of ≥10% within the first 6 months after CLAD onset or with a FEV 1 ‐decline of ≥100 ml/month during follow‐up (so‐called “rapid” decliners) appear to have a particularly poor survival . Similar findings are reported in BOS after hematopoietic stem cell transplantation (HSCT) . Treatment options for BOS are limited .…”

Bronchiolitis obliterans syndrome as manifestation of lung GVHD: Not the only one

“…We read with interest the article of Kwok et al 1 that sheds some light on the clinical course of patients with bronchiolitis obliterans syndrome (BOS) as a manifestation of graft-versus-host disease (GVHD) following haematopoietic stem cell transplantation (HSCT), a complex field that has received limited attention in the literature.…”

“…We appreciate the comments from Dr Marco Mura and Dr Stephen Juvet on our recent publication in Respirology. 1 They have raised two very important issues for further discussion: (i) radiographic diagnostic criteria for bronchiolitis obliterans syndrome (BOS) and (ii) presence or development of other noninfectious complications, in addition to BOS, that may also represent graft-versus-host-disease (GVHD) after haematopoietic stem cell transplantation (HSCT).…”

“…In our study, the available imaging results, including chest radiographs and computed tomography (CT) thorax at the time of diagnosis of BOS, were reviewed and compared with the available imaging studies before the diagnosis of BOS was made. 1 Most of the CT scans were reported to show various degree of air trapping, and none of them was reported to have diffuse, bilateral airspace opacities or features that may indicate development of idiopathic pneumonia syndrome. 2 With subsequent follow-up, however, some CT scans did report some degree of local traction bronchiectasis that we believe…”

Bronchiolitis obliterans syndrome ‘endotypes’ in haematopoietic stem cell transplantation

“…In this issue of the journal, Kwok et al . carefully interrogate a large and well‐nurtured cohort of haematopoietic stem cell transplant recipients searching for distinct BOS phenotypes.…”