Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Transplant Toxicities

Bronchiolitis obliterans in patients undergoing allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 49, pages 812–817 (2014)Cite this article

Subjects

Abstract

Bronchiolitis obliterans (BO) is a severe pulmonary complication of allo-SCT. This study evaluated the incidence of BO in patients undergoing allo-SCT in Hospital Universitário da Universidade Federal do Paraná, risk factors for developing this complication and prognostic factors for those patients who developed this entity. The study included 1286 patients transplanted between 1979 and 2009 who survived for 100 days or more. We diagnosed 53 cases of BO. The cumulative incidence was 2.9% in 1 year and 3.7% in 3 years. Among patients with chronic GVHD, the cumulative incidence at the same intervals was 8.4% and 9.9%, respectively. The median time between transplantation and diagnosis of BO was 260 days (49–3877 days). In the multivariate analysis the risk factors for BO were female donor, older recipients and acute GVHD. The main prognostic factor was the severity of pulmonary impairment. Patients who developed BO earlier than 260 days had a worse prognosis than those who did so later. At least 80% of deaths were directly related to BO.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Chan CK, Hyland RH, Hutcheon MA, Minden MD, Alexander MA, Kossakowska AE et al. Small-airways disease in recipients of allogeneic bone marrow transplants. An analysis of 11 cases and a review of the literature. Medicine 1987; 66: 327–340.

    Article  CAS  PubMed  Google Scholar 

  2. Clark JG, Schwartz DA, Flournoy N, Sullivan KM, Crawford SW, Thomas ED . Risk factors for airflow obstruction in recipients of bone marrow transplants. Ann Intern Med 1987; 107: 648–656.

    Article  CAS  PubMed  Google Scholar 

  3. Holland HK, Wingard JR, Beschorner WE, Saral R, Santos GW . Bronchiolitis obliterans in bone marrow transplantation and its relationship to chronic graft-v-host disease and low serum IgG. Blood 1988; 72: 621–627.

    CAS  PubMed  Google Scholar 

  4. Clark JG, Crawford SW, Madtes DK, Sullivan KM . Obstructive lung disease after allogeneic marrow transplantation. Clinical presentation and course. Ann Intern Med 1989; 111: 368–376.

    Article  CAS  PubMed  Google Scholar 

  5. Schwarer AP, Hughes JM, Trotman-Dickenson B, Krausz T, Goldman JM . A chronic pulmonary syndrome associated with graft-versus-host disease after allogeneic marrow transplantation. Transplantation 1992; 54: 1002–1008.

    Article  CAS  PubMed  Google Scholar 

  6. Dudek AZ, Mahaseth H, DeFor TE, Weisdorf DJ . Bronchiolitis obliterans in chronic graft-versus-host disease: analysis of risk factors and treatment outcomes. Biol Blood Marrow Transplant 2003; 9: 657–666.

    Article  PubMed  Google Scholar 

  7. Santo Tomas LH, Loberiza FR Jr, Klein JP, Layde PM, Lipchik RJ, Rizzo JD et al. Risk factors for bronchiolitis obliterans in allogeneic hematopoietic stem-cell transplantation for leukemia. Chest 2005; 128: 153–161.

    Article  PubMed  Google Scholar 

  8. Paz HL, Crilley P, Topolsky DL, Coll WX, Patchefsky A, Brodsky I . Bronchiolitis obliterans after bone marrow transplantation: the effect of preconditioning. Respiration 1993; 60: 109–114.

    Article  CAS  PubMed  Google Scholar 

  9. Crawford SW, Clark JG . Bronchiolitis associated with bone marrow transplantation. Clin Chest Med 1993; 14: 741–749.

    CAS  PubMed  Google Scholar 

  10. Au BK, Au MA, Chien JW . Bronchiolitis obliterans syndrome epidemiology after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2011; 17: 1072–1078.

    Article  PubMed  Google Scholar 

  11. Yoshihara S, Tateishi U, Ando T, Kunitoh H, Suyama H, Onishi Y et al. Lower incidence of bronchiolitis obliterans in allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning compared with myeloablative conditioning. Bone Marrow Transplant 2005; 35: 1195–1200.

    Article  CAS  PubMed  Google Scholar 

  12. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–956.

    PubMed  Google Scholar 

  13. Nakaseko C, Ozawa S, Sakaida E, Sakai M, Kanda Y, Oshima K et al. Incidence, risk factors and outcomes of bronchiolitis obliterans after allogeneic stem cell transplantation. Int J Hematol 2011; 93: 375–382.

    Article  PubMed  Google Scholar 

  14. Forslow U, Mattsson J, Gustafsson T, Remberger M . Donor lymphocyte infusion may reduce the incidence of bronchiolitis obliterans after allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2011; 17: 1214–1221.

    Article  PubMed  Google Scholar 

  15. Bacigalupo A, Ballen K, Rizzo D, Giralt S, Lazarus H, Ho V et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant 2009; 15: 1628–1633.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hildebrandt GC, Fazekas T, Lawitschka A, Bertz H, Greinix H, Halter J et al. Diagnosis and treatment of pulmonary chronic GVHD: report from the consensus conference on clinical practice in chronic GVHD. Bone Marrow Transplant 2011; 46: 1283–1295.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Duncan CN, Buonanno MR, Barry EV, Myers K, Peritz D, Lehmann L . Bronchiolitis obliterans following pediatric allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2008; 41: 971–975.

    Article  CAS  PubMed  Google Scholar 

  18. Curtis DJ, Smale A, Thien F, Schwarer AP, Szer J . Chronic airflow obstruction in long-term survivors of allogeneic bone marrow transplantation. Bone Marrow Transplant 1995; 16: 169–173.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universidade Federal do Paraná, Curitiba, Brazil

    A G Vieira, V A M Funke, E C Nunes, R Frare & R Pasquini

Authors
  1. A G Vieira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V A M Funke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E C Nunes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Frare
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R Pasquini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A G Vieira.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on Bone Marrow Transplantation website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vieira, A., Funke, V., Nunes, E. et al. Bronchiolitis obliterans in patients undergoing allogeneic hematopoietic SCT. Bone Marrow Transplant 49, 812–817 (2014). https://doi.org/10.1038/bmt.2014.25

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2014.25

This article is cited by

Search

Advanced search

Quick links