Early and rapid development of bronchiolitis obliterans syndrome after allogeneic hematopoietic cell transplantation

Jacqueline S Dickey; Burton F Dickey; Amin M Alousi; Richard E Champlin; Ajay Sheshadri

doi:10.1016/j.rmcr.2024.102001

Early and rapid development of bronchiolitis obliterans syndrome after allogeneic hematopoietic cell transplantation

Respir Med Case Rep. 2024 Mar 11:49:102001. doi: 10.1016/j.rmcr.2024.102001. eCollection 2024.

Authors

Jacqueline S Dickey¹, Burton F Dickey², Amin M Alousi³, Richard E Champlin³, Ajay Sheshadri²

Affiliations

¹ University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA.
² The University of Texas MD Anderson Cancer Center, Department of Pulmonary Medicine, Houston, TX, USA.
³ The University of Texas MD Anderson Cancer Center, Department of Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA.

Abstract

Bronchiolitis obliterans (BO) is a form of graft-versus-host disease (GVHD) in the lung and manifests as moderate to severe airflow obstruction after hematopoietic stem cell transplantation (HCT). New-onset airflow obstruction on spirometry is considered diagnostic of bronchiolitis obliterans syndrome (BOS). BOS affects about 5% of all HCT recipients. In general, BO is thought of as a late complication of HCT, usually occurring after day 100 post-transplantation. However, the onset of airflow obstruction can be rapid and is most often irreversible even with treatment. We describe a patient who rapidly developed severe airflow obstruction less than one month after transplantation following the development of upper airway symptoms. Despite aggressive immunosuppression, the patient had no improvement in airflow obstruction. We hypothesize that early screening and treatment may help prevent BOS after HCT.

Keywords: Bronchiolitis obliterans syndrome; Handheld spirometry; Hematopoietic cell transplantation; Screening.

Publication types

Case Reports