Updated prevalence, predictors and treatment outcomes for bronchiolitis obliterans syndrome after allogeneic stem cell transplantation

Pham, Jonathan; Rangaswamy, Jhanavi; Avery, Sharon; Borg, Brigitte M.; Martin, Catherine; Munsif, Maitri; Lin, Tiffany; Dabscheck, Eli

doi:10.1016/j.rmed.2020.106286

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…Bronchiolitis obliterans is a manifestation of chronic GVHD and is characterized by new-onset fixed airflow obstruction after allogeneic HSCT. The incidence of bronchiolitis obliterans ranges from 2% to 14% post-allogeneic HSCT and has a mortality rate of 50% [ 88 , 89 , 90 , 91 , 92 , 93 ]. Non-Caucasian race, lower baseline forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), and presence of chronic GVHD were risk factors for bronchiolitis obliterans.…”

Section: Resultsmentioning

confidence: 99%

Long-Term Health Effects of Curative Therapies on Heart, Lungs, and Kidneys for Individuals with Sickle Cell Disease Compared to Those with Hematologic Malignancies

Fitzhugh

Volanakis

Idassi

et al. 2022

JCM

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The goal of curing children and adults with sickle cell disease (SCD) is to maximize benefits and minimize intermediate and long-term adverse outcomes so that individuals can live an average life span with a high quality of life. While greater than 2000 individuals with SCD have been treated with curative therapy, systematic studies have not been performed to evaluate the long-term health effects of hematopoietic stem cell transplant (HSCT) in this population. Individuals with SCD suffer progressive heart, lung, and kidney disease prior to curative therapy. In adults, these sequalae are associated with earlier death. In comparison, individuals who undergo HSCT for cancer are heavily pretreated with chemotherapy, resulting in potential acute and chronic heart, lung, and kidney disease. The long-term health effects on the heart, lung, and kidney for children and adults undergoing HSCT for cancer have been extensively investigated. These studies provide the best available data to extrapolate the possible late health effects after curative therapy for SCD. Future research is needed to evaluate whether HSCT abates, stabilizes, or exacerbates heart, lung, kidney, and other diseases in children and adults with SCD receiving myeloablative and non-myeloablative conditioning regimens for curative therapy.

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Section: Resultsmentioning

confidence: 99%

Long-Term Health Effects of Curative Therapies on Heart, Lungs, and Kidneys for Individuals with Sickle Cell Disease Compared to Those with Hematologic Malignancies

Fitzhugh

Volanakis

Idassi

et al. 2022

JCM

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“…GVHD-BOS usually develops between 100 days and 2 years of HSCT, but onset beyond 5–6 years post-HSCT has been noted, usually in patients experiencing an extrapulmonary GVHD flare [ 7 , 16 , 17 ]. Risk factors for GVHD-BOS are impaired lung function before and early after HSCT, a myeloablative/busulfan-containing conditioning regimen, CMV seropositivity, pre-transplant history of pulmonary disease, female donor, unrelated donor and prior acute GVHD; receipt of antithymocyte globulin, which decreases chronic GVHD risk, reduces the risk of BOS [ 17 , 18 , 38 ].…”

Section: What Are Clad-bos and Chronic Gvhd-bos?mentioning

confidence: 99%

“…BOS after lung transplantation is the most common phenotype of chronic lung allograft dysfunction (CLAD), developing in up to 50% of recipients by the fifth post-transplant year and is the major cause of late post-transplant mortality [11][12][13]. BOS after HSCT is less common, affecting 2-10% of recipients within 5 years [14][15][16][17][18][19][20]. BOS is the lung manifestation of multisystemic graft-versus-host disease (GVHD), with a prevalence of 14% in patients with chronic GVHD [21].…”

Section: Introductionmentioning

confidence: 99%

“…BOS is the lung manifestation of multisystemic graft- versus -host disease (GVHD), with a prevalence of 14% in patients with chronic GVHD [ 21 ]. BOS negatively impacts prognosis after lung transplantation and HSCT [ 11 – 13 , 18 , 21 – 23 ]. However, as data required to confirm evidence-based therapeutic recommendations are limited, treatment is generally consensus driven [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Bronchiolitis obliterans syndrome after lung or haematopoietic stem cell transplantation: current management and future directions

et al. 2022

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Bronchiolitis obliterans syndrome (BOS) may develop after either lung or haematopoietic stem cell transplantation (HSCT), with similarities in histopathological features and clinical manifestations. However, there are differences in the contributory factors and clinical trajectories between the two conditions. BOS after HSCT occurs due to systemic graft-versus-host-disease (GVHD), whereas BOS after lung transplantation is limited to the lung allograft. BOS diagnosis after HSCT is more challenging, as the lung function decline may occur due to extrapulmonary GVHD, causing sclerosis or inflammation in the fascia or muscles of the respiratory girdle. Treatment is generally empirical with no established effective therapies. This review provides rare insights and commonalities of both conditions, that are not well elaborated elsewhere in contemporary literature, and highlights the importance of cross disciplinary learning from experts in other transplant modalities. Treatment algorithms for each condition are presented, based on the published literature and consensus clinical opinion. Immunosuppression should be optimised, and other conditions or contributory factors treated where possible. When initial treatment fails, the ultimate therapeutic option is lung transplantation (or re-transplantation in the case of BOS after lung transplantation) in carefully selected candidates. Novel therapies under investigation include aerosolised liposomal cyclosporine, Janus kinase inhibitors, antifibrotic therapies, and (in patients with BOS after lung transplantation) B-cell–directed therapies. Effective novel treatments that have a tangible impact on survival and thereby avoid the need for lung transplantation or re-transplantation are urgently required.

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“…Despite current treatment strategies including systemic or inhaled corticosteroids, azithromycin, and extracorporeal photodynamic therapy, patients with BOS still carry a poor prognosis 2,5,6 . The different treatment strategies aim more toward limiting further decline of the respiratory function than reversing the obstructive defect 6–8 …”

Section: Introductionmentioning

confidence: 99%

Successful treatment of severe post hematopoietic stem cell transplantation bronchiolitis obliterans syndrome with lung transplantation in a patient with multi‐organ chronic graft‐versus‐host disease

Pénichoux

Bouclet

Alani

et al. 2022

Clinical Case Reports

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Updated prevalence, predictors and treatment outcomes for bronchiolitis obliterans syndrome after allogeneic stem cell transplantation

Cited by 11 publications

References 22 publications

Long-Term Health Effects of Curative Therapies on Heart, Lungs, and Kidneys for Individuals with Sickle Cell Disease Compared to Those with Hematologic Malignancies

Long-Term Health Effects of Curative Therapies on Heart, Lungs, and Kidneys for Individuals with Sickle Cell Disease Compared to Those with Hematologic Malignancies

Bronchiolitis obliterans syndrome after lung or haematopoietic stem cell transplantation: current management and future directions

Successful treatment of severe post hematopoietic stem cell transplantation bronchiolitis obliterans syndrome with lung transplantation in a patient with multi‐organ chronic graft‐versus‐host disease

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