Relationship between FEV1 decline and mortality in patients with bronchiolitis obliterans syndrome-a systematic literature review

Robert Kemp; Iwona Pustulka; Gerhard Boerner; Beata Smela; Emilie Hofstetter; Yuliya Sabeva; Clément François

doi:10.1016/j.rmed.2021.106608

Relationship between FEV₁ decline and mortality in patients with bronchiolitis obliterans syndrome-a systematic literature review

Respir Med. 2021 Nov:188:106608. doi: 10.1016/j.rmed.2021.106608. Epub 2021 Sep 10.

Authors

Robert Kemp¹, Iwona Pustulka², Gerhard Boerner³, Beata Smela², Emilie Hofstetter⁴, Yuliya Sabeva⁵, Clément François⁶

Affiliations

¹ Breath Therapeutics, a Zambon Company, Menlo Park, CA, USA.
² HEOR, Creativ-Ceutical, Kraków, Poland.
³ Breath Therapeutics, a Zambon Company, Munich, Germany.
⁴ HealthStrat Consulting, Munich, Germany.
⁵ HEOR, Creativ-Ceutical, Sofia, Bulgaria.
⁶ HEOR, Creativ-Ceutical, Paris, France. Electronic address: clement.francois@creativ-ceutical.com.

PMID: 34517199
DOI: 10.1016/j.rmed.2021.106608

Abstract

Background: Bronchiolitis obliterans syndrome (BOS) is one of the most severe complications and the leading cause of late mortality and morbidity after lung transplantation (LT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT). No approved treatment for BOS is available. This review aimed to systematically identify and summarise the findings regarding the relationship between FEV₁ decline and mortality in patients who developed BOS following LT or allo-HSCT.

Methods: A systematic literature search was performed in the Medline, Embase and Cochrane reviews databases. Of the 501 potential studies identified 25 met inclusion criteria and were analysed.

Results: Overall, 13 studies reported a relationship between FEV₁ and mortality, and 12 studies reported both mortality and FEV₁ results but did not investigate the relationship between them. There was heterogeneity in the analyses, which investigated the relationship between FEV₁ decline and mortality across the studies in terms of levels of lung functioning, comparison to a control group, treatment, and statistical methodology; nevertheless, a clear and consistent increase in the risk of death associated with FEV₁ decrease was seen in the analysed studies.

Conclusions: The systematic literature review identified studies and findings that support a relationship between FEV₁ and mortality, with a decrease in FEV₁ being statistically associated with increased risk of death. Knowing that lower FEV₁ levels are associated with higher mortality rates may help assess the condition of a patient with BOS and monitor future treatment effectiveness. However, more evidence is needed to further investigate this relationship and to verify its clinical usefulness.

Keywords: Bronchiolitis obliterans syndrome; Chronic lung allograft dysfunction; Disease burden; FEV1; Hematopoietic stem cell transplantation complications; Lung transplantation complications; Mortality.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Bronchiolitis Obliterans / mortality*
Bronchiolitis Obliterans / physiopathology*
Forced Expiratory Volume*
Hematopoietic Stem Cell Transplantation*
Humans
Lung Transplantation*
Postoperative Complications / mortality*
Postoperative Complications / physiopathology*
Prognosis
Syndrome