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Clinical risk factors and prognostic model for patients with bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 59, pages 239–246 (2024)Cite this article

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Abstract

Bronchiolitis obliterans syndrome (BOS) is a common and potentially devastating noninfectious pulmonary complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Currently, predictive tools for BOS are not available. We aimed to identify the clinical risk factors and establish a prognostic model for BOS in patients who undergo allo-HSCT. We retrospectively identified a cohort comprising 195 BOS patients from 6100 consecutive patients who were allografted between 2008 and 2022. The entire cohort was divided into a derivation cohort and a validation cohort based on the time of transplantation. Via multivariable Cox regression methods, declining forced expiratory volume at 1 s (FEV1) to <40%, pneumonia, cGVHD except lung, and respiratory failure were found to be independent risk factors for the 3-year mortality of BOS. A risk score called FACT was constructed based on the regression coefficients. The FACT model had an AUC of 0.863 (95% CI: 0.797–0.928) in internal validation and 0.749 (95% CI: 0.621–0.876) in external validation. The calibration curves showed good agreement between the FACT-predicted probabilities and actual observations. The FACT risk score will help to identify patients at high risk and facilitate future research on developing novel, effective interventions to personalize treatment.

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Fig. 1: Cohort selection and model development.
Fig. 2: The predictive accuracy, calibration plot, and decision curve analysis of the FACT model for predicting 3-year mortality.
Fig. 3: Overall survival of patients with BOS after allo-HSCT by FACT risk group.

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Data availability

The data analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported by National Key Research and Development Program of China (No. 2021YFC2500304), Key Program of National Natural Science Foundation of China (No. 82230004), National Natural Science Foundation of China (No. 81970113), Youth Program of National Natural Science Foundation of China (No. 82200136), and the Capital Health Research and Development of Special (No. 2022-1-4082).

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  1. These authors contributed equally: Qiu-Sha Huang, Tian-Xiao Han.

Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, Beijing, China

    Qiu-Sha Huang, Tian-Xiao Han, Qi Chen, Jin Wu, Peng Zhao, Ye-Jun Wu, Yun He, Xiao-Lu Zhu, Hai-Xia Fu, Feng-Rong Wang, Yuan-Yuan Zhang, Xiao-Dong Mo, Wei Han, Chen-Hua Yan, Jing-Zhi Wang, Huan Chen, Yu-Hong Chen, Ting-Ting Han, Meng Lv, Yao Chen, Yu Wang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang

  2. National Clinical Research Center for Hematologic Disease, Beijing, China

    Qiu-Sha Huang, Tian-Xiao Han, Qi Chen, Jin Wu, Peng Zhao, Ye-Jun Wu, Yun He, Xiao-Lu Zhu, Hai-Xia Fu, Feng-Rong Wang, Yuan-Yuan Zhang, Xiao-Dong Mo, Wei Han, Chen-Hua Yan, Jing-Zhi Wang, Huan Chen, Yu-Hong Chen, Ting-Ting Han, Meng Lv, Yao Chen, Yu Wang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang

  3. Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

    Qiu-Sha Huang, Tian-Xiao Han, Qi Chen, Jin Wu, Peng Zhao, Ye-Jun Wu, Yun He, Xiao-Lu Zhu, Hai-Xia Fu, Feng-Rong Wang, Yuan-Yuan Zhang, Xiao-Dong Mo, Wei Han, Chen-Hua Yan, Jing-Zhi Wang, Huan Chen, Yu-Hong Chen, Ting-Ting Han, Meng Lv, Yao Chen, Yu Wang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang

  4. Collaborative Innovation Center of Hematology, Peking University, Beijing, China

    Qiu-Sha Huang, Tian-Xiao Han, Qi Chen, Jin Wu, Peng Zhao, Ye-Jun Wu, Yun He, Xiao-Lu Zhu, Hai-Xia Fu, Feng-Rong Wang, Yuan-Yuan Zhang, Xiao-Dong Mo, Wei Han, Chen-Hua Yan, Jing-Zhi Wang, Huan Chen, Yu-Hong Chen, Ting-Ting Han, Meng Lv, Yao Chen, Yu Wang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang

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Contributions

XHZ, QSH and TXH contributed to the concept and design. PZ, YJW, YH, XLZ, HXF, FRW, YYZ, XDM, WH, CHY, JZW, HC, YHC, TTH, ML, YC, QSH and TXH collected the data. QSH and XHZ contributed to data interpretation and data analysis. XHZ, QSH and TXH performed statistical analysis. YW, LPX, KYL, XJH and XHZ revised it critically. XHZ, QSH and TXH wrote the manuscript. XHZ designed, conceived and supervised the study, analyzed the data, and drafted and revised the manuscript. All authors critically reviewed and approved the final version of the manuscript.

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Correspondence to Xiao-Hui Zhang.

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Huang, QS., Han, TX., Chen, Q. et al. Clinical risk factors and prognostic model for patients with bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Bone Marrow Transplant 59, 239–246 (2024). https://doi.org/10.1038/s41409-023-02151-9

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