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O'Brien H, Murray J, Orfali N, Fahy RJ. Pulmonary complications of bone marrow transplantation. Breathe (Sheff) 2024; 20:240043. [PMID: 39360022 PMCID: PMC11444492 DOI: 10.1183/20734735.0043-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/15/2024] [Indexed: 10/04/2024] Open
Abstract
Bone marrow transplantation, now often known as haematopoietic stem cell transplantation (HSCT), is a complex choreographed procedure used to treat both acquired and inherited disorders of the bone marrow. It has proven invaluable as therapy for haematological and immunological disorders, and more recently in the treatment of metabolic and enzyme disorders. As the number of performed transplants grows annually, and with patients enjoying improved survival, a knowledge of both early and late complications of HSCT is essential for respiratory trainees and physicians in practice. This article highlights the spectrum of respiratory complications, both infectious and non-infectious, the timeline of their likely occurrence, and the approaches used for diagnosis and treatment, keeping in mind that more than one entity may occur simultaneously. As respiratory issues are often a leading cause of short- and long-term morbidity, consideration of a combined haematology/respiratory clinic may prove useful in this patient population.
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Affiliation(s)
- Helen O'Brien
- Division of Respiratory Medicine, St James Hospital, Dublin, Ireland
- These authors contributed equally
| | - John Murray
- Division of Respiratory Medicine, St James Hospital, Dublin, Ireland
- These authors contributed equally
| | - Nina Orfali
- Division of Haematology, St James Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ruairi J. Fahy
- Division of Respiratory Medicine, St James Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Nakao S, Tsukamoto S, Takeda Y, Ohwada C, Ri C, Izumi S, Kamata Y, Matsui S, Shibamiya A, Ishii A, Takaishi K, Takahashi K, Shiko Y, Oshima-Hasegawa N, Muto T, Mimura N, Yokote K, Nakaseko C, Sakaida E. Clinical impact of airflow obstruction after allogeneic hematopoietic stem cell transplantation. Int J Hematol 2024; 120:501-511. [PMID: 39190255 DOI: 10.1007/s12185-024-03831-y] [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: 12/06/2023] [Revised: 07/19/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
Criteria for airflow obstruction (AFO) at one year after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in pulmonary function tests (PFTs) are more stringent than the bronchiolitis obliterans syndrome (BOS) criteria of the National Institutes of Health. This single-center, retrospective cohort study evaluated the clinical impact of the AFO criteria at any time after transplantation. In 132 patients who underwent allo-HSCT from 2006 to 2016, the 2-year cumulative incidence of AFO was 35.0%, and the median time to diagnosis of AFO was 101 days after transplantation (range 35-716 days). Overall chronic graft-versus-host disease (cGVHD) incidence was significantly higher in patients with AFO than in those without AFO (80.4% vs. 47.7%, P < 0.01); notably, 37.0% of patients with AFO developed cGVHD after AFO diagnosis. AFO patients developed BOS with a 5-year cumulative incidence of 49.1% after AFO onset. The 5-year cumulative incidence of non-relapse mortality in the AFO group was higher than that in the non-AFO group (24.7% vs. 7.1%, P < 0.01). These results suggest that closely monitoring PFTs within two years after allo-HSCT, regardless of cGVHD status, is important for early detection of AFO and prevention of progression to BOS. (192words).
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Affiliation(s)
- Sanshiro Nakao
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shokichi Tsukamoto
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Takeda
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Chikako Ohwada
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
- Department of Hematology, International University of Health and Welfare, Narita, Japan
| | - Chihiro Ri
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
| | - Shintaro Izumi
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
| | - Yuri Kamata
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
| | - Shinichiro Matsui
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
| | - Asuka Shibamiya
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
| | - Arata Ishii
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
| | - Koji Takaishi
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
| | - Kohei Takahashi
- Biostatistics Section, Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Nagisa Oshima-Hasegawa
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
- Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital, Chiba, Japan
| | - Tomoya Muto
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
| | - Naoya Mimura
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan
- Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital, Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Chiaki Nakaseko
- Department of Hematology, International University of Health and Welfare, Narita, Japan
| | - Emiko Sakaida
- Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan.
- Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan.
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan.
- Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital, Chiba, Japan.
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Torralba-García Y, Alsina-Restoy X, Torres-Castro R, Gimeno-Santos E, de Llobet-Viladons N, Rovira-Tarrats M, Borràs-Maixenchs N, Valverde-Bosch M, García-Navarro CA, Vilaró J, Blanco I. Six-minute walking distance and desaturation-distance ratio in allogeneic stem cell transplantation. Eur J Clin Invest 2024; 54:e14151. [PMID: 38193580 DOI: 10.1111/eci.14151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Most patients with haematological malignancies who undergo allogeneic haematopoietic stem cell transplant (HSCT) receive chemotherapy before the transplant to control the disease. Certain chemotherapy drugs can cause lung toxicity. Conversely, in patients with chronic respiratory conditions, the 6-min walking test (6MWT) and the desaturation-distance ratio (DDR) have demonstrated prognostic significance. Our objective was to determine whether the 6MWD and DDR, assessed prior to HSCT, have a prognostic impact on survival at 24 months post-HSCT. METHODS A prospective experimental study was conducted in consecutive patients referred for allogeneic HSCT at Hospital Clinic, Barcelona, Spain. A complete functional respiratory study, including the 6MWT and DDR, was conducted prior to admission. The area under the curve (AUC) and cut-off points were calculated. Data on patients' characteristics, HSCT details, main events, with a focus on lung complications, and survival at 24 months were analysed. RESULTS One hundred and seventy-five patients (39% women) with mean age of 48 ± 13 years old were included. Before HSCT, forced vital capacity and forced expiratory volume in the first second were 96% ± 13% predicted and 92% ± 14% predicted, respectively; corrected diffusing capacity for carbon monoxide 79% ± 15% predicted; 6MWD was 568 ± 83 m and DDR of .27 (.20-.41). The cut-off points for 6MWD and DDR were 566 m, [.58 95% CI (.51-.64)], p = .024 and .306, [.63 95% CI (.55-.70)], p = .0005, respectively. The survival rate at 24 months was 55%. CONCLUSION Our results showed that individuals who exhibit a 6MWD shorter than 566 ms or a decline in DDR beyond .306 experienced reduced survival rates at 24 months after HSCT.
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Affiliation(s)
- Yolanda Torralba-García
- Bone Marrow Transplantation Unit. Hematological and Oncological Medicine Department, ICMHO, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre in Respiratory Diseases (CIBERES), Madrid, Spain
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Alsina-Restoy
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Rodrigo Torres-Castro
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
- Department of Physical Therapy. Faculty of Medicine, University of Chile, Santiago de Chile, Chile
| | - Elena Gimeno-Santos
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
- Rehabilitation Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Noemi de Llobet-Viladons
- Bone Marrow Transplantation Unit. Hematological and Oncological Medicine Department, ICMHO, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Rovira-Tarrats
- Bone Marrow Transplantation Unit. Hematological and Oncological Medicine Department, ICMHO, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nuria Borràs-Maixenchs
- Bone Marrow Transplantation Unit. Hematological and Oncological Medicine Department, ICMHO, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Montserrat Valverde-Bosch
- Bone Marrow Transplantation Unit. Hematological and Oncological Medicine Department, ICMHO, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Carles Agustí García-Navarro
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jordi Vilaró
- Blanquerna School of Health Sciences, Global Research on Wellbeing (GRoW), Ramon Llull University, Barcelona, Spain
| | - Isabel Blanco
- Biomedical Research Networking Centre in Respiratory Diseases (CIBERES), Madrid, Spain
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
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Fraebel J, Engelhardt BG, Kim TK. Noninfectious Pulmonary Complications after Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023; 29:82-93. [PMID: 36427785 DOI: 10.1016/j.jtct.2022.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
Pulmonary complications after hematopoietic stem cell transplantation (HSCT) are important sources of morbidity and mortality. Improvements in infection-related complications have made noninfectious pulmonary complications an increasingly significant driver of transplantation-related mortality. Broadly, these complications can be characterized as either early or late complications, with idiopathic pneumonia syndrome and bronchiolitis obliterans syndrome the most prevalent early and late complications, respectively. Outcomes with historical treatment consisting mainly of corticosteroids are often poor, highlighting the need for a deeper understanding of these complications' underlying disease biology to guide the adoption of novel therapies that are being increasingly used in the modern era.
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Affiliation(s)
- Johnathan Fraebel
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian G Engelhardt
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Tae Kon Kim
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Center for Immunobiology, Nashville, Tennessee; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee.
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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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