title: Incidence, risk factors and outcomes of bronchiolitis obliterans after allogeneic stem cell transplantation.
abstract: Bronchiolitis obliterans (BO) after allogeneic stem cell transplantation (allo-SCT) is a late-onset, life-threatening respiratory complication that significantly reduces a patient's quality of life. We retrospectively analysed the incidence of and risk factors for BO in allo-SCT recipients. In 2087 patients who underwent allo-SCT between January 1994 and June 2005 and survived >90 days after transplantation, 57 patients developed BO with a 5-year cumulative incidence of 2.8%. The median time interval from transplantation to BO diagnosis was 335 days (range 83-907 days). The 5-year cumulative incidence of BO was 1.62% in bone marrow transplantation (BMT) from related donors, 3.83% in peripheral blood stem cell transplantation (PBSCT) from related donors (R-PBSCT), 2.91% in BMT from unrelated donors and 2.65% in unrelated cord blood transplantation. The incidence of BO after R-PBSCT was significantly higher than that after any other type of allo-SCT (p = 0.02). R-PBSCT (p = 0.019) and preceding chronic graft-versus-host disease (GVHD) (p < 0.001) were BO-associated risk factors. Overall 5-year survival of patients with BO from the time of diagnosis was 45.4%, significantly less than those without (77.5% from day 335, p < 0.001). R-PBSCT recipients with existent chronic GVHD have a high risk of developing BO, and need extensive care and repeated pulmonary function tests.
authors.affiliation: Department of Hematology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. chiaki-nakaseko@faculty.chiba-u.jp.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nakaseko
authors.affiliation: Department of Hematology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ozawa
authors.affiliation: Department of Hematology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Emiko
authors.initials: E
authors.lastname: Sakaida
authors.affiliation: Department of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
authors.forename: Miwa
authors.initials: M
authors.lastname: Sakai
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Kumi
authors.initials: K
authors.lastname: Oshima
authors.affiliation: Department of Hematology and Oncology, The University of Tokyo, Tokyo, Japan.
authors.forename: Mineo
authors.initials: M
authors.lastname: Kurokawa
authors.affiliation: Department of Hematology and Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Hematology and Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Ooi
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yokota
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yoshiba
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
authors.forename: Katsumichi
authors.initials: K
authors.lastname: Fujimaki
authors.affiliation: Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Heiwa
authors.initials: H
authors.lastname: Kanamori
authors.affiliation: Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.|Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Sakai
authors.affiliation: Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Saitoh
authors.affiliation: Division of Hematology, Saiseikai Maebashi Hospital, Maebashi, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Sakura
authors.affiliation: Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Maruta
authors.affiliation: Department of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Okamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000401:mortality*; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous