Bronchiectasis after allogeneic hematopoietic cell transplantation – an underdiagnosed complication - 02/07/25
, Yitzhac Hadad b, c, Anne Bergeron d, Sabrina Fried a, b, Gidon Pomerantz a, b, Avshalom Shaffer a, b, Dolev Paz a, b, Nevo Barel b, e, Tal Moshe Perluk a, b, Odelia Amit b, f, Ron Ram b, f, Amir Bar-Shai a, bAbstract |
Background |
Bronchiectasis (BE) following allogeneic hematopoietic cell transplantation (allo-HCT) are described in the context of bronchiolitis obliterans syndrome (BOS). However, data on its overall prevalence and characteristics in allo-HCT patients are scarce.
Objectives |
To assess the prevalence, characteristics, and outcomes of symptomatic new-onset bronchiectasis after allo-HCT.
Methods |
A prospective database with all subjects that underwent allo-HCT between 2014 and 2022 in a tertiary center was utilized. Chest CT scans of subjects with respiratory symptoms were analyzed and compared to pre-HCT scans for BE. Changes in pulmonary function tests (PFTs) and mortality were compared between patients with and without BE.
Results |
Overall, 282 subjects underwent allo-HCT and 182 survived at 6 months. Thirty-six patients (20 %) were diagnosed with new-onset BE. Median (IQR) duration from HCT to BE diagnosis was 304 (202–547) days. Of those with BE and serial PFTs, 39 % met the criteria for BOS. Independent predictors for BE included chronic graft vs. host disease (adjusted OR 6.8, 95 % CI 1.34–34.6) and a lower baseline FEV1 % (aOR 0.95, 95 % CI 0.92–0.98). BE was associated with increased hazard of mortality (HR 1.91, 95 % CI 1.1–3.6), validated by an extended cox model and sub-group analyses. Patients meeting the criteria for BOS had lower follow-up PFTs and a higher rate of diffuse distribution of bronchiectasis (67 % vs. 32 %). Moreover, patients with BOS had increased mortality compared to BE not meeting these criteria (HR 3.40, 95 % CI 1.2–9.4).
Conclusions |
Bronchiectasis is prevalent after allo-HCT with major impact, not solely explained by BOS.
Le texte complet de cet article est disponible en PDF.Highlights |
• | 182 patients after allogeneic hematopoietic cell transplantation that survived at 6 months. |
• | 20 % had symptomatic new-onset bronchiectasis during their follow-up. |
• | Of those with bronchiectasis, 39 % met the clinical NIH criteria for bronchiolitis obliterans. |
• | Non-pulmonary graft vs. host disease occurred in 92 % of patients with bronchiectasis. |
Keywords : Bronchiectasis, Diagnosis, Immunosuppression, Pulmonary functions, Chronic graft versus host disease
Plan
Vol 245
Article 108208- août 2025 Retour au numéro
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