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Impact of lung function on bronchiolitis obliterans syndrome and outcome after allogeneic hematopoietic cell transplantation with reduced intensity conditioning
Duque-Afonso, J., Ihorst, G., Waterhouse, M., Zeiser, R., Wasch, R., Bertz, H., Muller-Quernheim, J., Finke, J., Marks, R., Prasse, A.
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
Abstract
Lung function deterioration contributes to treatment-related morbidity and mortality in patients after allogeneic hematopoietic cell transplantation (allo-HCT). Better understanding of impaired lung function including bronchiolitis obliterans syndrome (BOS) as chronic manifestation of Graft-versus-Host-Disease (GvHD) might improve outcomes of patients after allo-HCT. In order to detect early pulmonary function tests abnormalities associated with BOS incidence and outcome after allo-HCT, we performed a retrospective analysis of homogenous-treated 445 patients (median age 61.9 years, range 19-76) with a reduced intensity/toxicity conditioning protocol. The cumulative incidence of BOS was 4.1% (95% CI 2.6-6.4) at 1 year and 8.6% (95% CI 6.3-11.6) at 5 year after allo-HCT with a median follow-up of 43.2 months (range 3.3-209). In multivariate analysis, pre-existence of moderate small airway disease reflected by decreased mid-expiratory flows prior allo-HCT was associated with increased risk for BOS development. In addition, severe small airway disease prior allo-HCT and combined restrictive/obstructive lung disease at day +100 after allo-HCT were associated with higher risk for non-relapse mortality due mainly to pulmonary cause of death. In summary, we identified novel pulmonary function tests abnormalities prior and after allo-HCT associated with BOS development and non-relapse mortality. These findings might help to identify a risk population and result in personalized GvHD prophylaxis and preventive or early therapeutic interventions.