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Nyilas, S; Baumeler, L; Tamm, M; Halter, JP; Savic, S; Korten, I; Meyer, A; Singer, F; Passweg, JR; Latzin, P; Stolz, D.
Inert Gas Washout in Bronchiolitis Obliterans Following Hematopoietic Cell Transplantation.
Chest. 2018; 154(1):157-168 Doi: 10.1016/j.chest.2017.12.009
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Co-authors Med Uni Graz: Singer Florian
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Abstract:: BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is a leading cause of chronic graft-vs-host disease (cGvHD) and is associated with mortality after allogeneic hematopoietic stem cell transplantation (alloHSCT). The nitrogen multiple breath washout test (N₂-MBW) measures ventilation inhomogeneity, a biomarker of central and peripheral airway obstruction. The aim of this study was to examine ventilation inhomogeneity according to cGvHD score and histologically defined bronchiolitis obliterans (BO). METHODS: This single-center prospective cross-sectional study included 225 adults (mean age, 52.8 years; median, 5.4 years [interquartile range, 2.0-11 years]) after alloHSCT. Outcomes were global (lung clearance index [LCI]) and acinar ventilation inhomogeneity index (S_ACIN) from N₂-MBW. Patients were categorized into five groups: (1) no cGvHD and no obstruction (cGvHD overall score 0 and FEV₁/FVC ≥ 70) (2) cGvHD and no obstruction (cGvHD overall score 1-3 and FEV₁/FVC ≥ 70), (3) BOS with or without cGvHD (if available, no BO on histologic examination, and FEV₁/FVC < 70), (4) histologically proven BO, and (5) diffuse parenchymal lung disease other than BO. RESULTS: The LCI and S_ACIN differed significantly between groups (P < .001) and increased progressively according to cGvHD score. In BO, the LCI and S_ACIN were elevated in 95.5% and 81.8% of patients, respectively, whereas FEV₁/FVC was abnormal in only 56.5% of patients, respectively. CONCLUSIONS: N₂-MBW is highly sensitive for detecting abnormal lung function in patients following alloHSCT. LCI and S_ACIN seem to be promising biomarkers of lung involvement in cGvHD.
Find related publications in this database (using NLM MeSH Indexing): Breath Tests - methods; Bronchiolitis Obliterans - complications, diagnosis, physiopathology; Cross-Sectional Studies - administration & dosage; Female - administration & dosage; Follow-Up Studies - administration & dosage; Forced Expiratory Volume - administration & dosage; Graft vs Host Disease - diagnosis, etiology; Hematopoietic Stem Cell Transplantation - adverse effects; Humans - administration & dosage; Lung - diagnostic imaging, physiopathology; Male - administration & dosage; Middle Aged - administration & dosage; Prognosis - administration & dosage; Prospective Studies - administration & dosage; Tomography, X-Ray Computed - administration & dosage; Transplant Recipients - administration & dosage; Vital Capacity - administration & dosage
Find related publications in this database (Keywords): allogeneic hematopoietic stem cell transplantation; bronchiolitis obliterans; inert gas washout