Abstract
Introduction: Cytomegalovirus (CMV) infection is a well-studied complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). It remains one of the causes of graft- versus-host disease (GVHD), despite widespread prevention and treatment.
Aims and objectives: To define the role of CMV infection in the development of bronchiolitis obliterans syndrome (BOS).
Methods: Our group examined 1142 patients after allo-HSCT between 2012 - 2014. Pulmonary function test (PFT) was performed in all patients. Patients with BOS underwent high-resolution computer tomography (HRCT), bronchoscopy with complex microbiological diagnostics of bronchoalveolar lavage (BAL), control of CMV replication in blood, BAL and urine; 4 patients underwent videothoracoscopic lung biopsy with histological examination.
Results: BOS was diagnosed in 24 (2%) patients between 4 and 14 months after allo-HSCT. Male/female – 10/14, 16 - 56 years old; OLL - 10, OML - 7, HL - 4, CLL - 1, MDS - 1, MM - 1; conditioning regimen – myeloablative/nonmyeloablative – 13/11. Allo-HSCT from related donor were performed in 5 patients, unrelated - 17, haplo - 2. In patients with BOS in the first 100 days after allo-HSCT, CMV was detected in blood in 15 cases, in BAL – 2, in urine - 1, 6 patients had no CMV reactivation. Persistent obstructive interruptions on PFT (FEV1 < 80%), mosaic perfusion and bronchial wall thickening on HRCT and no signs of active infection have been detected in all patients during the observation.
Conclusions: Patients after allo-HSCT are susceptible to CMV infection, especially, in the first 100 days. CMV infection can provoke the development of BOS in the period between 4 and 14 months.
- Copyright ©ERS 2015