Abstract
Introduction: Bronchiolitis obliterans (BO) is thought to be a rare complication with poor prognosis after hematopoietic stem cell transplantation (HSCT).
Method: We analyzed 825 patients who received HSCT between 2003 and 2013 at our hospital. Diagnosis of BO was made according to the NIHdefinition in 12 patients (1.5%).
Result: The 12 patients with BO included six males (50%), and median age was 41 years (range, 18–63 years). The medium period from HSCT to diagnosis of BO was 21 months. Mean values for %FEV1, FEV1%, %RV/TLC and %PEFR were 43%, 48.7%, 140.2% and 42%, respectively, at the time of diagnosis. In seven cases, declines in pulmonary function tests (PFT) antecedent to the appearance of findings on computed tomography (CT) were detected. In all cases, dose of systemic corticosteroid was increased after onset of BO. Bronchodilators were used in 10 patients, inhaled corticosteroids in 10, and oral macrolides in five. After the start of treatment, FEV1% improved in five patients, and the mean difference in FEV1.0% between pre- and post-treatment was +3.7%. Median survival time from diagnosis of BO was 33.7 months. The 2- and 5-year survival rates were 58% and 25%, respectively. The most common cause of death was respiratory infection (five cases), followed by carcinoma in another organ (two cases) and unknown (two cases). All three patients who survived less than 1 year died of infection (two with bacterial pneumonia, one with pulmonary aspergillosis).
Conclusion: Early detection of BO may be achieved by PFT, although whether early initiation of treatment can improve outcomes remains unclear. Patients with adequate management of infection could become long-term survivors.
- © 2014 ERS