References

Amin EN, Phillips GS, Elder P, Jaglowski S, Devine SM, Wood KL. Health-related quality of life in patients who develop bronchiolitis obliterans syndrome following allo-SCT. Bone Marrow Transplant. 2015; 50:(2)289-295 https://doi.org/10.1038/bmt.2014.264

Au BK, Au MA, Chien JW. Bronchiolitis obliterans syndrome epidemiology after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2011; 17:(7)1072-1078 https://doi.org/10.1016/j.bbmt.2010.11.018

Carpenter PA, Kitko CL, Elad S National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report. Biol Blood Marrow Transplant. 2015; 21:(7)1167-1187 https://doi.org/10.1016/j.bbmt.2015.03.024

Cheng GS, Campbell AP, Xie H Correlation and agreement of handheld spirometry with laboratory spirometry in allogeneic hematopoietic cell transplant recipients. Biol Blood Marrow Transplant. 2016; 22:(5)925-931 https://doi.org/10.1016/j.bbmt.2015.12.023

Del Fante C, Perotti C. Extracorporeal photopheresis for bronchiolitis obliterans syndrome after allogeneic stem cell transplant: an emerging therapeutic approach?. Transfus Apher Sci. 2017; 56:(1)17-19 https://doi.org/10.1016/j.transci.2016.12.010

Efrati O, Toren A, Duskin H Pulmonary function studies in children treated by chemoradiotherapy and stem cell transplantation. Pediatr Blood Cancer. 2008; 51:(5)684-688 https://doi.org/10.1002/pbc.21722

Hildebrandt GC, Fazekas T, Lawitschka A Diagnosis and treatment of pulmonary chronic GVHD: report from the consensus conference on clinical practice in chronic GVHD. Bone Marrow Transplant. 2011; 46:(10)1283-1295 https://doi.org/10.1038/bmt.2011.35

Jagasia MH, Greinix HT, Arora M National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant. 2015; 21:(3)389-401.e1 https://doi.org/10.1016/j.bbmt.2014.12.001

Nunn AJ, Gregg I. New regression equations for predicting peak expiratory flow in adults. BMJ. 1989; 298:(6680)1068-1070 https://doi.org/10.1136/bmj.298.6680.1068

Palmer J. Early detection is key: is handheld spirometry the answer?. Biol Blood Marrow Transplant. 2016; 22:(5)780-781 https://doi.org/10.1016/j.bbmt.2016.03.002

Yoshihara S, Yanik G, Cooke KR, Mineishi S. Bronchiolitis obliterans syndrome (BOS), bronchiolitis obliterans organizing pneumonia (BOOP), and other late-onset noninfectious pulmonary complications following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2007; 13:(7)749-759 https://doi.org/10.1016/j.bbmt.2007.05.001

Monitoring lung function in patients with chronic graft versus host disease: a pilot study

10 October 2019
Professional
02 October 2019
Volume 28 · Issue 18

Abstract

Bronchiolitis obliterans syndrome (BOS) following allogenic haematopoietic stem cell transplant is considered the manifestation of chronic graft versus host disease (cGvHD) in the lung, and affects about 14% of patients with cGvHD, mainly in the first 2 years after transplant. Despite advances in assessment, diagnosis and treatment, the clinical prognosis remains poor for patients with pulmonary manifestations of cGvHD. A pilot study of 50 patients was devised to establish whether a relationship exists between forced expiratory volume in 1 second (FEV1) via pulmonary function test (PFT) and the equivalent peak expiratory flow (PEF) via peak flow handheld spirometry in cGvHD patients receiving extracorporeal photopheresis (ECP). Only PEF observed within 2 days of PFT could be compared with data at month 3, 6, 9 and 12. This pilot study illustrated that monitoring via handheld peak flow readings has the potential to become an acceptable method of monitoring lung function longitudinally in cGvHD patients.

Bronchiolitis obliterans syndrome (BOS) following allogenic haematopoietic stem cell transplant (HSCT) is considered the manifestation of chronic graft versus host disease (cGvHD) in the lung (Del Fante and Perotti, 2017). BOS affects about 14% of patients with cGvHD, mainly in the first 2 years following transplant (Au et al, 2011) and is one of the most frequent late-onset non-infectious pulmonary complications following HSCT (Del Fante and Perotti, 2017). BOS is characterised by progressive airflow obstruction in the absence of respiratory infection, which significantly affects patients' quality of life (Yoshihara et al, 2007; Amin et al, 2015). In the early stages of pulmonary cGvHD, although some patients may be asymptomatic the majority often present with non-specific symptoms such as mild dyspnoea on exertion or a dry, non-productive cough (Hildebandt et al, 2011). It was suggested by Efrati et al (2008) that functional and structural changes occur earlier than the manifestation of clinical symptoms and subsequent physical impairment. Pulmonary complications occurring following allogeneic HSCT substantially contribute to morbidity and late mortality in patients presenting with impaired lung function (Palmer, 2016).

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Chronic graft versus host disease
Spirometry
Peak flow
Pulmonary function test
Extracorporeal photopheresis