title: Bronchiolitis obliterans syndrome in adults after allogeneic stem cell transplantation-pathophysiology, diagnostics and treatment.
abstract: Transplant-related complications are common after allogeneic hematopoietic stem cell transplantation (allo-HSCT), including graft versus host disease (GVHD). The lungs are frequently affected during the course of allo-HSCT, and among the non-infectious pulmonary complications bronchiolitis obliterans syndrome (BOS) is the most common and considered the only diagnostic manifestation of pulmonary GVHD. BOS is an irreversible obstructive disease that affects the terminal bronchioles, and it is associated with high morbidity and mortality rates. Area covered: We discuss the features of chronic GVHD, including the pathophysiological and cytokine-mediated alteration in BOS. Early treatment, before structural and irreversible changes have occurred, is crucial to reduce disease morbidity and mortality. This is challenging, given the unspecific symptoms of early stage disease and the complexity of the disease pathophysiology, obstructing both the diagnostic workup and the initiation of treatment. We highlight the main issues regarding diagnostic challenges, and we discuss the treatment options with a focus on new therapeutic options and modalities. Expert commentary: BOS is one of the most serious late complications after allo-HSCT and remains a diagnostic and therapeutic challenge. Thus, new and more effective therapeutic alternatives are strongly warranted.
authors.affiliation: a Department of Medicine, Hematology , Haukeland University Hospital , Bergen , Norway.|b Department of Clinical Science , University of Bergen , Bergen , Norway.
authors.forename: Ida Sofie
authors.initials: IS
authors.lastname: Grønningsæter
authors.affiliation: a Department of Medicine, Hematology , Haukeland University Hospital , Bergen , Norway.
authors.forename: Galina
authors.initials: G
authors.lastname: Tsykunova
authors.affiliation: a Department of Medicine, Hematology , Haukeland University Hospital , Bergen , Norway.
authors.forename: Kyrre
authors.initials: K
authors.lastname: Lilleeng
authors.affiliation: a Department of Medicine, Hematology , Haukeland University Hospital , Bergen , Norway.
authors.forename: Aymen Bushra
authors.initials: AB
authors.lastname: Ahmed
authors.affiliation: a Department of Medicine, Hematology , Haukeland University Hospital , Bergen , Norway.|b Department of Clinical Science , University of Bergen , Bergen , Norway.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Bruserud
authors.affiliation: c Haraldsplass Deaconess Hospital , Bergen , Norway.
authors.forename: Håkon
authors.initials: H
authors.lastname: Reikvam
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D016207:Cytokines / Q000378:metabolism; D042241:Early Diagnosis; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008168:Lung / Q000276:immunology / Q000473:pathology*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous
chemical_list: D016207:Cytokines
keywords: Allogeneic stem cell transplantation; Cytokines; GVHD; Leukemia; Lung