Small-Airways Disease in Recipients of Allogeneic Bone Marrow Transplants

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.

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Gassas

Craig-Barnes

Dell

et al. 2012

“…Its occurrence has been linked to chronic graft-versus-host disease (cGVHD), 4-11 and its frequency has been estimated to range from 8 to 33%. 4,[6][7][8][12][13][14] Although defined histologically, the diagnosis is most often presumptive, made based on signs and symptoms, radiographic changes and PFT showing obstruction, hyperinflation and gas trapping.Restriction is a pattern of decreased lung volumes (TLC, best measured by body plethysmography), with a preserved FEV1/FVC ratio. Our group and others have identified a decrease in TLC post BMT which tends to improve over time, 3,11,[15][16][17] with a reported incidence of up to 24%.…”

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confidence: 99%

“…In the BMT population, the prototypical cause of obstruction is OB. Its occurrence has been linked to chronic graft-versus-host disease (cGVHD), [4][5][6][7][8][9][10][11] and its frequency has been estimated to range from 8 to 33%. 4,[6][7][8][12][13][14] Although defined histologically, the diagnosis is most often presumptive, made based on signs and symptoms, radiographic changes and PFT showing obstruction, hyperinflation and gas trapping.…”

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confidence: 99%

Pulmonary function abnormalities after allogeneic marrow transplantation: a systematic review and assessment of an existing predictive instrument

Marras

Szalai

Chan

et al. 2002

Summary:Pulmonary function testing (PFT) is used to characterize non-infectious pulmonary complications after allogeneic BMT. Identifying high-risk patients could facilitate preventive or early therapeutic measures. The objectives of the study were first, to review available data on PFT changes after BMT and second, to validate a previously published predictive index for PFT obstruction in patients transplanted at one center. For the systematic review, frequency, severity and time course of PFT changes after BMT and for the validation study, retrospective cohort comparing predicted with observed PFT, and calculation of indices of predictive accuracy were summarized. The validation study involved 434 patients from Princess Margaret Hospital, Toronto, Canada, who received their first BMT between 1980 and 1997, survived for at least 6 months and had adequate PFT follow-up. The systematic review included 20 studies. After BMT, decreased diffusion and total lung capacity were common and partially reversible. Obstruction was less common. The validation study of a previously published index, performed in 434 patients, found a sensitivity and specificity of 48% and 68% for identifying patients who develop obstruction. We concluded that PFT changes after BMT are common. A published predictive index is not sufficiently accurate to identify high-risk patients for potential preventive or early therapeutic strategies. The lung is often a target organ for complications after allogeneic marrow transplantation (BMT), 1,2 with pulmonary complications including infection, neoplasia, and idiopathic and iatrogenic disorders such as pulmonary edema, diffuse alveolar hemorrhage and obliterative bronchiolitis (OB). In the latter process, bronchioles become progressively constricted and obliterated from intramural infiltration, fibrosis and scarring. 1 After BMT, pulmonary function testing (PFT) can be useful to help diagnose complications, and in routine follow-up, as PFT abnormalities correlate with non-relapse mortality. 3 There are three main categories of PFT abnormalities. Obstructive defects occur when there is small airway closure or obstruction on expiration, leading to diminished forced expiratory volumes (one second forced expiratory volume -FEV1), classically with a preserved forced vital capacity (FVC), resulting in a decrease in FEV1/FVC ratio. In the BMT population, the prototypical cause of obstruction is OB. Its occurrence has been linked to chronic graft-versus-host disease (cGVHD), 4-11 and its frequency has been estimated to range from 8 to 33%. 4,[6][7][8][12][13][14] Although defined histologically, the diagnosis is most often presumptive, made based on signs and symptoms, radiographic changes and PFT showing obstruction, hyperinflation and gas trapping.Restriction is a pattern of decreased lung volumes (TLC, best measured by body plethysmography), with a preserved FEV1/FVC ratio. Our group and others have identified a decrease in TLC post BMT which tends to improve over time, 3,11,[15][16][17] with a reported inc...

“…8,9 After the first case report of fatal bronchiolitis in an allo-HSCT recipient with chronic GVHD (cGVHD) in 1982, 10 a series of LONIPCs were described in 1987 as smallairway disease in recipients of allo-HSCT. 11 In 1998, Palmas et al 12 classified LONIPCs after allo-HSCT into five groups: bronchiolitis obliterans (BO), bronchiolitis obliterans with organizing pneumonia (BOOP), diffuse alveolar damage, lymphocytic interstitial pneumonia and nonclassifiable pneumonia. According to this classification, BO was diagnosed based on the obstructive pattern in pulmonary function tests (PFTs) and the other LONIPCs on histological findings.…”

Section: Introductionmentioning

confidence: 99%

Outcome and treatment of late-onset noninfectious pulmonary complications after allogeneic haematopoietic SCT

Ueda

Watadani

Maeda

et al. 2010

Late-onset noninfectious pulmonary complications (LONIPCs) are life threatening for allogeneic hematopoietic SCT (allo-HSCT) recipients. However, the impact of LONIPCs on survival has not been properly evaluated and little is known about treatment efficacy. We retrospectively investigated 290 allo-HSCT recipients in our institute and reviewed the clinical aspects of 44 patients who had been diagnosed with LONIPCs. LONIPCs were significantly associated with higher rates of chronic GVHD (Po0001) and nonrelapse mortality (P ¼ 0.013), and lower rates of relapse (P ¼ 0.009). As a result of these effects, OS was significantly worse in those with LONIPCs (P ¼ 0.003). This result differs from a previous report. We then assessed short-term treatment response and final outcome. These results were defined by radiological findings, subjective symptoms, oxygen requirement and survival. Use of inhaled and systemic steroids did not affect either short-term response or final outcomes. However, administration of systemic corticosteroids earlier than at 21 days (median interval of time from onset of symptoms to systemic corticosteroids administration) was associated with a better outcome (P ¼ 0.054 for short-term response, and 0.016 for final outcome). Our study indicates that LONIPCs reduce OS, and early intervention with systemic corticosteroids may be effective.