Clin Pediatr Hematol Oncol.  2015 Oct;22(2):127-135. 10.15264/cpho.2015.22.2.127.

Bronchiolitis Obliterans Syndrome after Allogenic Hematopoietic Stem Cell Transplantation in Pediatric Patients

• Lim JY
• Hahn SM
• Kim HS
• Han JW
• Lyu CJ

• KMID: 2084612
• DOI: http://doi.org/10.15264/cpho.2015.22.2.127

Abstract

BACKGROUND
Bronchiolitis obliterans syndrome (BOS) is a life-threatening lung complication after allogenic hematopoietic stem cell transplantation (HSCT). As long-term survival following allogenic HSCT has improved, the number of BOS patients has been steadily increased. However, the survival and treatment of BOS have not improved significantly for decades. Identification of risk factors of BOS would improve the clinical outcome of allogenic HSCT recipients.
METHODS
We retrospectively investigated medical records of 147 allogenic HSCT recipients between 2005 and 2014 in Yonsei Cancer Center. Risk factors for BOS were analyzed with Chi-square test, logistic regression analysis, and the Student's t-test.
RESULTS
BOS occurred to 23 patients (15.6%). Pulmonary function test (PFT) results before transplantation were similar in all patients, but patients with BOS had a significant decrease in forced expiratory volume in one second (FEV1) after transplantation compared with controls (68.4+/-26.4% vs. 91.6+/-21.0%, P<0.05). Acute graft-versus-host disease (GVHD) (OR 5.98, P=0.009) and peripheral blood as sources of stem cell (OR 4.00, P=0.031) increased risk for BOS, respectively. On the other hand, previously reported risk factors, such as age of donors and recipients, pulmonary infection within 100 days after allogenic HSCT and deference of immunosuppressant were not associated with increased the incidence of BOS in our study.
CONCLUSION
We report here the result of a single-center study on the incidence, clinical factors, and outcome of BOS after allogenic HSCT. BOS is an important cause of post-transplantation morbidity and mortality. Risk reduction can be achieved by better prevention and control of BOS.

Keyword

Bronchiolitis obliterans syndrome; Hematopoietic stem cell transplantation; Graft versus host disease

MeSH Terms

Bronchiolitis Obliterans*
Bronchiolitis*
Forced Expiratory Volume
Graft vs Host Disease
Hand
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Incidence
Logistic Models
Lung
Medical Records
Mortality
Respiratory Function Tests
Retrospective Studies
Risk Factors
Risk Reduction Behavior
Stem Cells
Tissue Donors