Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Transplant Cell Ther. 2024 May;30(5):524.e1-524.e9. doi: 10.1016/j.jtct.2024.02.013. Epub 2024 Feb 14.
Bronchiolitis obliterans syndrome (BOS) is a severe complication following hemopoietic stem cell transplantation (HSCT) and is often undetected until there is significant deterioration in pulmonary function. Lung clearance index (LCI) derived from the nitrogen multiple breath washout (NMBW) test may be more feasible and sensitive than spirometry, which is currently used for surveillance and detection of BOS. We aimed to examine the feasibility of performing surveillance NMBW in children post-HSCT, and in an exploratory analysis, determine if LCI led to earlier detection of BOS when compared to spirometric indices. Participants aged 5 to 17 years were recruited prior to receiving HSCT into a prospective, single-center, feasibility study at the Royal Children's Hospital, Melbourne. NMBW and spirometry were performed within the month prior to transplant and repeated at 3, 6, 9, and 12 months post-transplant. Data were also collected on the presence of graft-versus-host (GVHD) disease in any organ, including the lungs. Twenty-one (12 male) children with a mean age of 13.4 (range 9.2 to 17.1) years at recruitment participated in this study. Prior to HSCT, all participants had normal LCI, while 16 (76%) demonstrated normal forced expiratory volume in 1 second (FEV). Ninety-nine percent of NMBW tests were technically acceptable, compared with 66% of spirometry tests. Three participants developed BOS, while 2 participants died of other respiratory complications. At 6 and 12 months post-transplant, the BOS group had increases in LCI ranging from 3 to 5 units and mean reductions in FEV % predicted of 40% to 53% relative to pre HSCT values, respectively. In those who developed BOS, post-HSCT LCI values were significantly worse when compared with the no BOS group (P < .001). Relative changes in LCI and FEV were both predictive of BOS at 6 months post HSCT. This study demonstrates that NMBW is a more feasible test compared with spirometry in children post HSCT. However, in an exploratory analysis, LCI did not lead to earlier detection of BOS, when compared to spirometry.
闭塞性细支气管炎综合征（BOS）是造血干细胞移植（HSCT）后的严重并发症，通常在肺功能明显恶化后才被发现。从氮多呼吸冲洗（NMBW）试验中得出的肺清除指数（LCI）可能比目前用于监测和检测 BOS 的肺活量计更可行和敏感。我们旨在研究在 HSCT 后对儿童进行监测性 NMBW 的可行性，并进行探索性分析，以确定与肺活量计指数相比，LCI 是否能更早地发现 BOS。 在墨尔本皇家儿童医院进行的一项前瞻性、单中心可行性研究中，在接受 HSCT 之前，招募了年龄在 5 至 17 岁的参与者。在移植前一个月内进行 NMBW 和肺活量计检查，并在移植后 3、6、9 和 12 个月重复检查。还收集了任何器官（包括肺部）移植物抗宿主病（GVHD）的存在数据。 本研究共纳入 21 名（12 名男性）儿童，招募时平均年龄为 13.4 岁（范围 9.2 至 17.1 岁）。在 HSCT 之前，所有参与者的 LCI 均正常，而 16 名（76%）的 FEV1 正常。NMBW 测试的技术合格率为 99%，而肺活量计测试的技术合格率为 66%。3 名参与者发生 BOS，2 名参与者因其他呼吸并发症死亡。在移植后 6 个月和 12 个月时，BOS 组的 LCI 分别增加了 3 至 5 个单位，FEV%预测值与 HSCT 前相比分别减少了 40%至 53%。在发生 BOS 的患者中，与无 BOS 组相比，HSCT 后 LCI 值明显更差（P<.001）。LCI 和 FEV 的相对变化均能预测 6 个月时的 HSCT 后 BOS。本研究表明，与 HSCT 后儿童的肺活量计相比，NMBW 是一种更可行的测试方法。然而，在探索性分析中，与肺活量计相比，LCI 并未更早地检测到 BOS。
