Updated prevalence and risk factors for bronchiolitis obliterans syndrome after allogeneic stem cell transplantation

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Introduction: The development of bronchiolitis obliterans syndrome (BOS) after allogeneic stem cell transplant (SCT) continues to confer a poor prognosis despite recent advances in conditioning regimens, supportive care and treatment of graft-versus-host disease (GVHD). Aim: To assess the prevalence of BOS (using recent diagnostic criteria for BOS and updated spirometry reference values); and to identify risk factors associated with current SCT practices. Method: Clinical data was retrospectively collected on 447 patients who underwent allogeneic haematopoetic stem cell transplantation at a large Australian tertiary hospital between 2007 and 2017. Spirometry was performed prior to and post-transplant in 275 of these patients. The primary outcome was the development of BOS based on the spirometric definition provided by the 2014 NIH consensus guideline. (Jagasia, M.H. et al. Biol Blood Marrow Transplant. 2015;21(3):389-401) Result: 25 out of 275 patients (9%) developed the primary outcome. Factors significantly associated with the development of BOS included: a myeloablative conditioning regimen (representing 44% of the population but 64% of the primary outcome, P = 0.03); and the presence of chronic GVHD (representing 49% of the population but 70% of the primary outcome, P = 0.03). Conclusion: The results show that the prevalence of bronchiolitis obliterans syndrome in allogeneic stem cell transplant remains significant, and that development of BOS may be associated with specific factors such as conditioning regimen and GVHD. Further research aimed at identifying and modifying these factors is likely to reduce the significant morbidity associated with this disease.

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