Risk Factors for Bronchiolitis Obliterans Syndrome after Initial Detection of Pulmonary Impairment after Hematopoietic Cell Transplantation

• Published in: Transplantation and cellular therapy 2023-03, Vol.29 (3), p.204.e1-204.e7
• Main Authors: Alkhunaizi, Mansour, Patel, Badar, Bueno, Luis, Bhan, Neel, Ahmed, Tahreem, Arain, Muhammad H., Saliba, Rima, Rondon, Gabriela, Dickey, Burton F., Bashoura, Lara, Ost, David E., Li, Liang, Wang, Shikun, Shpall, Elizabeth, Champlin, Richard E., Mehta, Rohtesh, Popat, Uday R., Hosing, Chitra, Alousi, Amin M., Sheshadri, Ajay
• Format: Article
• Language: English
• Subjects: Bronchiolitis Obliterans - diagnosis; Bronchiolitis Obliterans - epidemiology; Bronchiolitis Obliterans - etiology; Bronchiolitis Obliterans Syndrome; Graft-versus-host disease; Hematopoietic cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary function testing; Retrospective Studies; Risk Factors
• ISSN: 2666-6367; 2666-6375; 2666-6367
• DOI: 10.1016/j.jtct.2022.12.001

•Forty-two percent of allogeneic hematopoietic cell transplantation (HCT) recipients developed new pulmonary impairment after HCT.•Active cGVHD and airflow obstruction increase risk for bronchiolitis obliterans syndrome (BOS) after initial impairment.•The absence of both cGVHD and airflow obstruction essentially rules out future BOS.•High-risk HCT recipients may benefit from more intensive pulmonary monitoring. Pulmonary chronic graft-versus-host-disease (cGVHD), or bronchiolitis obliterans syndrome (BOS), is a highly morbid complication of hematopoietic cell transplantation (HCT). The clinical significance of a single instance of pulmonary decline not meeting the criteria for BOS is unclear. We conducted a retrospective analysis in a cohort of patients who had an initial post-HCT decline in the absolute value of forced expiratory volume in 1 second (FEV1) of ≥10% or mid-expiratory flow rate of ≥25% but not meeting the criteria for BOS (pre-BOS). We examined the impact of clinical variables in patients with pre-BOS on the risk for subsequent BOS. Pre-BOS developed in 1325 of 3170 patients (42%), of whom 72 (5%) later developed BOS. Eighty-four patients developed BOS without detection of pre-BOS by routine screening. Among patients with pre-BOS, after adjusting for other significant variables, airflow obstruction (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.1 to 3.7; P = .02), percent-predicted FEV1 on decline (HR, .98; 95% CI, .97 to 1.0; P = .02), active cGVHD (HR, 7.7; 95% CI, 3.1 to 19.3; P < .001), peripheral blood stem cell source (HR, 3.8; 95% CI, 1.7 to 8.6; P = .001), and myeloablative conditioning (HR, 2.0; 95% CI, 1.1 to 3.5; P = .02) were associated with subsequent BOS. The absence of airflow obstruction and cGVHD had a negative predictive value of 100% at 6 months for subsequent BOS, but the positive predictive value of both factors was low (cGVHD, 3%; any obstruction, 4%; combined, 6%). Several clinical factors at the time of pre-BOS, particularly active cGVHD and airflow obstruction, increase the risk for subsequent BOS. These factors merit consideration to be included in screening practices to improve the detection of BOS, with the caveat that the predictive utility of these factors is limited by the overall low incidence of BOS among patients with pre-BOS. [Display omitted]