title: Airway dilation in bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Bronchiolitis obliterans syndrome (BOS) is a late, non-infectious pulmonary complication following hematopoietic stem cell transplantation (HSCT). There is minimal data published on quantitative radiologic characterization of airway remodeling in these subjects.
  
  
  OBJECTIVE
  To examine quantitative measurements of airway morphology and their correlation with lung function in a cohort of patients who underwent HSCT and developed BOS.
  
  
  METHODS
  All adult patients who underwent allogeneic HSCT at the Dana-Farber Cancer Institute/Brigham and Women's Hospital (n = 1854) between January 1st 2000 and June 30th 2010 were screened for the development of BOS. Clinically acquired high resolution CT (HRCT) scans of the chest were collected. For each subjects discrete measures of airway wall area were performed and the square root of wall area of a 10-mm luminal perimeter (Pi10) was calculated.
  
  
  RESULTS
  We identified 88 cases of BOS, and 37 of these patients had available HRCT. On CT scans obtained after BOS diagnosis, the Pi10 decreased (consistent with airway dilation) as compared with pre-BOS values (p < 0.001). After HSCT the Pi10 correlated with FEV(1)% predicted (r = 0.636, p < 0.0001), and RV/TLC% predicted (r = -0.736, p < 0.0001), even after adjusting for age, sex and total lung capacity (p < 0.0001 for both).
  
  
  CONCLUSIONS
  On HRCT scan BOS is characterized by central airway dilation, the degree of which is correlated to decrements in lung function. This is opposite of what has been previously demonstrated in COPD and asthma that quantitative measure of proximal airway wall thickening directly correlate with pulmonary function. Our data suggests that the pathologic process affecting the central airways is different from the pathology observed in the distal airways. Further work is needed to determine if such change can be used as a sensitive and specific tool for the future diagnosis and staging of BOS.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States. lgazourian@partners.org
authors.forename: Lee
authors.initials: L
authors.lastname: Gazourian
authors.forename: Anna Maria F
authors.initials: AM
authors.lastname: Coronata
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Rogers
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Weinhouse
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Jerome
authors.initials: J
authors.lastname: Ritz
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Ho
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Baron
authors.forename: George R
authors.initials: GR
authors.lastname: Washko
mesh_terms: D000328:Adult; D000368:Aged; D056151:Airway Remodeling / Q000502:physiology; D001980:Bronchi / Q000473:pathology*; D001989:Bronchiolitis Obliterans / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D001995:Bronchography / Q000379:methods; D016022:Case-Control Studies; D004108:Dilatation, Pathologic / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult