title: Bronchiolitis obliterans after allogeneic hematopoietic SCT: further insight--new perspectives?
abstract: Bronchiolitis obliterans (BO) is a late non-infectious pulmonary complication after allogeneic hematopoietic SCT. Among 982 patients after myeloablative hematopoietic SCT between January 2000 and October 2010, 68 were diagnosed with BO according to NIH criteria. The median onset of BO was 18 months post transplant, 5-year cumulative incidence was 5.8% and 5-year mortality 41%. BO prevalence rate was 10% among all long-term surviving hematopoietic SCT recipients and 12% among chronic GVHD-patients. Chronic GVHD, peripheral SCT and ABO blood group incompatibility were identified as risk factors associated with BO. IgG levels were significantly decreased at the onset of BO (6.7 g/L±0.7, P=0.001), the mean exhaled NO concentrations were lower in BO-patients than in stem cell recipients without BO (14 p.p.b.±0.9 vs 20 p.p.b.±2.1) or healthy controls (25 p.p.b.±2.4, P<0.001). Hypoxia-inducible factor 1 alpha (HIF-1α) was significantly elevated in BO as compared with healthy controls or GVHD-patients without lung involvement (340±61 vs 127±22 vs 140±32, P=0.02). Calculated 5-year survival was superior in female than in male BO-patients (86 vs 45%, P=0.04). These results emphasize the relevance of BO as serious late complication with substantial mortality and point to essential pathophysiological changes due to regulatory responses to hypoxia.
authors: Department of Bone Marrow Transplantation, WTZ, Comprehensive Cancer Centre, University Hospital Essen, Hufelandstrasse 55, Essen, Germany. markus.ditschkowski@uk-essen.de
authors: M
authors: M
authors: Ditschkowski
authors: A H
authors: AH
authors: Elmaagacli
authors: M
authors: M
authors: Koldehoff
authors: T
authors: T
authors: Gromke
authors: R
authors: R
authors: Trenschel
authors: D W
authors: DW
authors: Beelen
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism*; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous
chemical_list: D009569:Nitric Oxide