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Westrupp N, Berry CD, Cole T, Shanthikumar S, Welsh L. Detection of Bronchiolitis Obliterans Syndrome Using Nitrogen Multiple Breath Washout in Children Posthemopoietic Stem Cell Transplant. Transplant Cell Ther 2024; 30:524.e1-524.e9. [PMID: 38360272 DOI: 10.1016/j.jtct.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Bronchiolitis obliterans syndrome (BOS) is a severe complication following hemopoietic stem cell transplantation (HSCT) and is often undetected until there is significant deterioration in pulmonary function. Lung clearance index (LCI2.5) derived from the nitrogen multiple breath washout (N2MBW) test may be more feasible and sensitive than spirometry, which is currently used for surveillance and detection of BOS. We aimed to examine the feasibility of performing surveillance N2MBW in children post-HSCT, and in an exploratory analysis, determine if LCI2.5 led to earlier detection of BOS when compared to spirometric indices. Participants aged 5 to 17 years were recruited prior to receiving HSCT into a prospective, single-center, feasibility study at the Royal Children's Hospital, Melbourne. N2MBW and spirometry were performed within the month prior to transplant and repeated at 3, 6, 9, and 12 months post-transplant. Data were also collected on the presence of graft-versus-host (GVHD) disease in any organ, including the lungs. Twenty-one (12 male) children with a mean age of 13.4 (range 9.2 to 17.1) years at recruitment participated in this study. Prior to HSCT, all participants had normal LCI2.5, while 16 (76%) demonstrated normal forced expiratory volume in 1 second (FEV1). Ninety-nine percent of N2MBW tests were technically acceptable, compared with 66% of spirometry tests. Three participants developed BOS, while 2 participants died of other respiratory complications. At 6 and 12 months post-transplant, the BOS group had increases in LCI2.5 ranging from 3 to 5 units and mean reductions in FEV1 % predicted of 40% to 53% relative to pre HSCT values, respectively. In those who developed BOS, post-HSCT LCI2.5 values were significantly worse when compared with the no BOS group (P < .001). Relative changes in LCI2.5 and FEV1 were both predictive of BOS at 6 months post HSCT. This study demonstrates that N2MBW is a more feasible test compared with spirometry in children post HSCT. However, in an exploratory analysis, LCI2.5 did not lead to earlier detection of BOS, when compared to spirometry.
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Affiliation(s)
- Nicole Westrupp
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Cassidy Du Berry
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Theresa Cole
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Shivanthan Shanthikumar
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Liam Welsh
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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Carla Chong-Silva1 D, Moreira Schneider1 P, de Almeida Pinto Jardim2 T, Nichele3 S, Loth3 G, Antônio Riedi1 C, José Chong Neto1 H, Maria Sales Bonfim3 C, Augusto Rosário Filho1 N. Pulmonary complications after hematopoietic stem cell transplantation in children: a functional and tomographic evaluation. J Bras Pneumol 2022; 48:e20220134. [PMID: 36169559 PMCID: PMC9496364 DOI: 10.36416/1806-3756/e20220134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Débora Carla Chong-Silva1
- 1. Serviço de Alergia, Imunologia e Pneumologia Pediátrica, Universidade Federal do Paraná, Curitiba (PR), Brasil
| | - Pollyana Moreira Schneider1
- 1. Serviço de Alergia, Imunologia e Pneumologia Pediátrica, Universidade Federal do Paraná, Curitiba (PR), Brasil
| | | | - Samantha Nichele3
- 3. Unidade de Transplante de Medula Óssea, Universidade Federal do Paraná, Curitiba (PR), Brasil
| | - Gisele Loth3
- 1. Serviço de Alergia, Imunologia e Pneumologia Pediátrica, Universidade Federal do Paraná, Curitiba (PR), Brasil
| | - Carlos Antônio Riedi1
- 1. Serviço de Alergia, Imunologia e Pneumologia Pediátrica, Universidade Federal do Paraná, Curitiba (PR), Brasil
| | - Herberto José Chong Neto1
- 1. Serviço de Alergia, Imunologia e Pneumologia Pediátrica, Universidade Federal do Paraná, Curitiba (PR), Brasil
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