Preventing and managing bronchiolitis obliterans syndrome after allogeneic hematopoietic cell transplantation

Abstract

Bronchiolitis obliterans syndrome is a potentially fatal complication of allogeneic hematopoietic cell transplantation that is defined as the development of new fixed airflow obstruction within the first 2 years after transplantation. The prevalence of this syndrome is estimated to be 5.5% among all allogeneic hematopoietic cell transplantation recipients, and 14% among all long-term survivors who develop chronic graft-versus-host disease. Although little is known about the pathogenesis of this syndrome, there are now clear guidelines for clinical diagnosis of bronchiolitis obliterans syndrome, and there appear to be promising new approaches towards treatment that can significantly reduce the morbidity associated with corticosteroid therapy. Future research efforts should target the identification of clinical biomarkers for risk stratification, early diagnosis and treatment-response assessment.

Keywords::

• bronchiolitis obliterans syndrome
• graft-versus-host disease
• hematopoietic cell transplantation

Financial & competing interests disclosure

This work was funded by NIH grant HL 088201. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

^†Recommended modifications to the NIH criteria [29].

FEV₁: Forced expiratory volume in 1 s; FVC: Forced vital capacity.