title: Biopsy-verified bronchiolitis obliterans and other noninfectious lung pathologies after allogeneic hematopoietic stem cell transplantation.
abstract: Bronchiolitis obliterans (BO) is a serious complication of allogeneic hematopoietic stem cell transplantation (HSCT). Lung biopsy is the gold standard for diagnosis. This study describes the course of BO and assesses the congruity between biopsy-verified BO and a modified version of the National Institutes of Health's consensus criteria for BO syndrome (BOS) based exclusively on noninvasive measures. We included 44 patients transplanted between 2000 and 2010 who underwent lung biopsy for suspected BO. Of those, 23 were diagnosed with BO and 21 presented other noninfectious pulmonary pathologies, such as cryptogenic organizing pneumonia, diffuse alveolar damage, interstitial pneumonia, and nonspecific interstitial fibrosis. Compared with patients with other noninfectious pulmonary pathologies, BO patients had significantly lower values of forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and maximal mid-expiratory flow throughout follow-up, but there was no difference in the change in pulmonary function from the time of lung biopsy. The BO diagnosis was not associated with poorer overall survival. Fifty-two percent of patients with biopsy-verified BO and 24% of patients with other noninfectious pulmonary pathology fulfilled the BOS criteria. Pathological BO diagnosis was not superior to BOS criteria in predicting decrease in pulmonary function beyond the time of biopsy. A lung biopsy may provide a characterization of pathological patterns that can extend our knowledge on the pathophysiology of HSCT-related lung diseases.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Institute for Inflammation Research, The Finsen Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Research Unit Women's and Children's Health, The Juliane Marie Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: hilde.hylland@gmail.com.
authors.forename: Hilde Hylland
authors.initials: HH
authors.lastname: Uhlving
authors.affiliation: Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Claus B
authors.initials: CB
authors.lastname: Andersen
authors.affiliation: The Finsen Laboratory & Biotech Research and Innovation Center (BRIC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ib Jarle
authors.initials: IJ
authors.lastname: Christensen
authors.affiliation: Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Gormsen
authors.affiliation: Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Karen Damgaard
authors.initials: KD
authors.lastname: Pedersen
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Pediatric Pulmonary Service, Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Frederik
authors.initials: F
authors.lastname: Buchvald
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Heilmann
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Pediatric Pulmonary Service, Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Kim Gjerum
authors.initials: KG
authors.lastname: Nielsen
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jann
authors.initials: J
authors.lastname: Mortensen
authors.affiliation: Department of Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Moser
authors.affiliation: Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Sengeløv
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Institute for Inflammation Research, The Finsen Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Klaus Gottlob
authors.initials: KG
authors.lastname: Müller
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000473:pathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology*; D008875:Middle Aged
keywords: Bronchiolitis obliterans; Bronchiolitis obliterans syndrome; Chronic graft-versus-host disease; Hematopoietic stem cell transplantation; Pulmonary function tests; Pulmonary pathology