Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia.
Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia.
Eur Respir Rev. 2023 Jul 26;32(169). doi: 10.1183/16000617.0251-2022. Print 2023 Sep 30.
Pulmonary chronic graft--host disease (cGVHD) is a substantial cause of pulmonary morbidity and mortality post-haematopoietic stem cell transplantation (HSCT). Current spirometry-based monitoring strategies have significant limitations. Understanding the utility of novel peripheral airway function tests - multiple breath washout (MBW) and oscillometry - is critical in efforts to improve detection, facilitate earlier intervention and improve outcomes. In this scoping review, we identified 17 studies investigating MBW or oscillometry, or both, after allogenic HSCT. Despite small study numbers limiting the ability to draw firm conclusions, several themes were evident. Detectable peripheral airway abnormality in MBW occurred in a substantial proportion prior to HSCT. MBW indices post-HSCT were more frequently abnormal than spirometry when reporting group data and among those with extrapulmonary cGVHD and pulmonary cGVHD. Changes in MBW indices over time may be more indicative of pulmonary complications than absolute values at any given time point. Oscillometry indices were often normal at baseline, but more frequently abnormal in those who developed pulmonary cGVHD. Pooling currently available individual participant data across these studies may improve our ability to formally compare their respective sensitivity and specificity at specific time points and assess the trajectory of MBW and oscillometry indices over time.
肺慢性移植物抗宿主病（cGVHD）是造血干细胞移植（HSCT）后肺部发病率和死亡率的重要原因。目前基于肺量计的监测策略存在显著局限性。了解新型周围气道功能测试——多次呼吸冲洗（MBW）和振荡法的实用性，对于提高检测能力、促进早期干预和改善结果至关重要。在本次范围界定综述中，我们确定了 17 项研究，这些研究调查了同种异体 HSCT 后的 MBW 或振荡法，或两者均有涉及。尽管研究数量较少限制了得出明确结论的能力，但有几个主题是明显的。在 HSCT 之前，MBW 中可检测到的周围气道异常在很大比例中发生。当报告组数据时，以及在外周性 cGVHD 和肺 cGVHD 患者中，HSCT 后 MBW 指数比肺量计更常异常。MBW 指数随时间的变化可能比任何特定时间点的绝对值更能提示肺部并发症。在基线时，振荡法指数通常正常，但在发生肺 cGVHD 的患者中更常异常。汇总这些研究中目前可用的个体参与者数据，可能会提高我们在特定时间点正式比较它们各自的敏感性和特异性的能力，并评估 MBW 和振荡法指数随时间的变化轨迹。
