title: Lung histology predicts outcome of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.
abstract: Bronchiolitis obliterans (BO) is a severe complication after allogeneic hematopoietic stem cell transplantation with an unfavorable prognosis. Lung biopsy remains the gold standard for diagnosis. In this retrospective single-center study, we describe 33 patients who underwent biopsy for suspected BO. Ten patients had constrictive BO (CBO); 9 had lymphocytic bronchiolitis (LB), characterized by lymphocytic infiltration of the bronchioles. Six additional patients (4, CBO; 2, LB) had concomitant infection; 8 had other pathological diagnoses. Seven patients with CBO and 3 with LB met the National Institutes of Health consensus BO syndrome definition criteria. An additional 7 patients with histologically confirmed CBO did not meet the consensus definition, 4 of them because of concomitant airway infection. At diagnosis, there were no significant differences between the CBO and LB groups in clinical presentation; pulmonary function tests (median forced expiratory volume in one second [FEV1] at baseline, 90.4% and 99% predicted, at time of video-assisted thoracoscopic surgery, 55.1% and 60.8% for CBO and LB groups, respectively); and chest scans. Treatment was similar in both groups but outcome was different depending on histological findings. FEV1 significantly improved in LB patients compared with CBO patients. Survivals at 1 and 3 years were 77% ± 12% and 60% ± 14% for patients with CBO and 91% ± 9% for patients with LB (P = .028). Lung biopsy in patients with suspected BO enables better characterization of the pattern of BO syndrome. In contrast to CBO, LB is associated with a good long-term prognosis.
authors.affiliation: Department of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Holbro
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehmann
authors.forename: Sabine
authors.initials: S
authors.lastname: Girsberger
authors.forename: Martin
authors.initials: M
authors.lastname: Stern
authors.forename: Franco
authors.initials: F
authors.lastname: Gambazzi
authors.forename: Didier
authors.initials: D
authors.lastname: Lardinois
authors.forename: Dominik
authors.initials: D
authors.lastname: Heim
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Passweg
authors.forename: André
authors.initials: A
authors.lastname: Tichelli
authors.forename: Lukas
authors.initials: L
authors.lastname: Bubendorf
authors.forename: Spasenija
authors.initials: S
authors.lastname: Savic
authors.forename: Katrin
authors.initials: K
authors.lastname: Hostettler
authors.forename: Peter
authors.initials: P
authors.lastname: Grendelmeier
authors.forename: Joerg P
authors.initials: JP
authors.lastname: Halter
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008168:Lung / Q000187:drug effects / Q000276:immunology / Q000473:pathology*; D008214:Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents
references.citation: Chest. 2005 Jul;128(1):8-10
references.pmid: 16002906
references.citation: Hematology Am Soc Hematol Educ Program. 2008;:125-33
references.pmid: 19074070
references.citation: Am J Respir Crit Care Med. 2005 Sep 15;172(6):772-5
references.pmid: 15976371
references.citation: Bone Marrow Transplant. 2005 Jun;35(12):1195-200
references.pmid: 15852024
references.citation: Biol Blood Marrow Transplant. 2011 Jul;17(7):1072-8
references.pmid: 21126596
references.citation: Bone Marrow Transplant. 2011 Oct;46(10):1283-95
references.pmid: 21441964
references.citation: N Engl J Med. 2010 Nov 25;363(22):2091-101
references.pmid: 21105791
references.citation: Eur Respir J Suppl. 1993 Mar;16:5-40
references.pmid: 8499054
references.citation: Blood. 2003 Dec 1;102(12):4236-42
references.pmid: 12907447
references.citation: Blood. 1988 Aug;72(2):621-7
references.pmid: 3042044
references.citation: Clin Infect Dis. 2008 Feb 1;46(3):402-12
references.pmid: 18181739
references.citation: Bone Marrow Transplant. 2000 Jun;25(12):1263-8
references.pmid: 10871731
references.citation: Virchows Arch. 1997 Oct;431(4):275-82
references.pmid: 9368665
references.citation: Blood. 2007 Nov 15;110(10):3784-92
references.pmid: 17671231
references.citation: Case Rep Hematol. 2012;2012:957612
references.pmid: 22957280
references.citation: Hum Pathol. 1995 Jun;26(6):668-75
references.pmid: 7774899
references.citation: Eur Respir J. 2005 Mar;25(3):490-3
references.pmid: 15738293
references.citation: Biol Blood Marrow Transplant. 2003 Oct;9(10):657-66
references.pmid: 14569562
references.citation: N Engl J Med. 1978 Nov 9;299(19):1030-6
references.pmid: 30044
references.citation: Biol Blood Marrow Transplant. 2005 Dec;11(12):945-56
references.pmid: 16338616
references.citation: Blood. 2003 Nov 15;102(10):3822-8
references.pmid: 12869516
references.citation: Expert Rev Respir Med. 2011 Feb;5(1):127-35
references.pmid: 21348593
references.citation: Biol Blood Marrow Transplant. 2010 Jan;16(1 Suppl):S106-14
references.pmid: 19896545
references.citation: Blood. 2009 Nov 12;114(20):4327-36
references.pmid: 19713461
references.citation: Curr Opin Hematol. 2006 Nov;13(6):426-35
references.pmid: 17053454
references.citation: Biol Blood Marrow Transplant. 2010 Jan;16(1):53-61
references.pmid: 20053332
references.citation: Chest. 2012 Oct;142(4):988-995
references.pmid: 22459769
references.citation: Blood. 2005 Oct 15;106(8):2912-9
references.pmid: 15994282
references.citation: JAMA. 2009 Jul 15;302(3):306-14
references.pmid: 19602690
references.citation: Chest. 2005 Jul;128(1):153-61
references.pmid: 16002929
references.citation: J Pediatr Surg. 2002 Mar;37(3):446-52
references.pmid: 11877664
references.citation: Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):723-9
references.pmid: 10712314
references.citation: Transplantation. 2004 Jan 27;77(2):275-80
references.pmid: 14742993