Yonsei Med J.  2016 Mar;57(2):365-372. 10.3349/ymj.2016.57.2.365.

Risk Factor and Clinical Outcome of Bronchiolitis Obliterans Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation

• Rhee CK
• Ha JH
• Yoon JH
• Cho BS
• Min WS
• Yoon HK
• Lee JW

• KMID: 2374041
• DOI: http://doi.org/10.3349/ymj.2016.57.2.365

Abstract

PURPOSE
The development of bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (HSCT) deteriorates patients' quality of life. This study aimed to analyze the prevalence, clinical features, risk factors and prognostic factors of BOS.
MATERIALS AND METHODS
This retrospective study included patients who underwent allogeneic HSCT from January 2002 to December 2008 and survived for > or =100 days after transplantation.
RESULTS
Of 860 patients who survived for > or =100 days, 36 (4.2%) met the diagnostic criteria. The duration of BOS development after transplantation was 466.00 (284.00-642.75) [median (interquartile range)] days. The risk factor for the development of BOS was peripheral blood as the stem cell source with a hazard ratio (HR) of 2.550 [95% confidence interval (CI): 1.274-5.104, p=0.008]. In multivariate analysis, pretransplant FEV1/FVC (HR: 0.956, 95% CI: 0.921-0.993, p=0.020) and time from HSCT to diagnosis of BOS (HR: 0.997, 95% CI: 0.994-0.999, p=0.009) were independent prognostic factors associated with mortality.
CONCLUSION
Peripheral blood as a stem cell source is a risk factor for the development of BOS. A decreased pretransplant FEV1/FVC and shorter duration of time from transplantation to diagnosis of BOS are poor prognostic factors for BOS.

Keyword

Bronchiolitis obliterans syndrome; hematopoietic stem cell transplantation; risk factor; prognosis

MeSH Terms

Adult
Aged
Bronchiolitis Obliterans/epidemiology/*etiology
Disease Progression
Female
Graft vs Host Disease/etiology
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans
Male
Middle Aged
Multivariate Analysis
Prevalence
Proportional Hazards Models
*Quality of Life
Respiratory Function Tests
Retrospective Studies
Risk Factors
Survival Analysis
Transplantation, Homologous

Figure

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  Fig. 1 Overall survival (OS) curves of patients with and without bronchiolitis obliterans syndrome (BOS). OS of patients who survived for (A) >100 days and (B) >554 days after HSCT. HSCT, hematopoietic stem cell transplantation.

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  Fig. 2 Survival curve for patients with bronchiolitis obliterans syndrome (BOS) according to prognostic factors (A: according to pretransplant FEV1/FVC adjusted for duration of time from HSCT to diagnosis of BOS, B: according to time from HSCT to diagnosis of BOS adjusted for pretransplant FEV1/FVC). Q, quartile; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; HSCT, hematopoietic stem cell transplantation.

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