Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan.
Blood and Marrow Transplant Center, Chiba University Hospital, Chiba, Japan.
Int J Hematol. 2024 Oct;120(4):501-511. doi: 10.1007/s12185-024-03831-y. Epub 2024 Aug 27.
Criteria for airflow obstruction (AFO) at one year after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in pulmonary function tests (PFTs) are more stringent than the bronchiolitis obliterans syndrome (BOS) criteria of the National Institutes of Health. This single-center, retrospective cohort study evaluated the clinical impact of the AFO criteria at any time after transplantation. In 132 patients who underwent allo-HSCT from 2006 to 2016, the 2-year cumulative incidence of AFO was 35.0%, and the median time to diagnosis of AFO was 101 days after transplantation (range 35-716 days). Overall chronic graft-versus-host disease (cGVHD) incidence was significantly higher in patients with AFO than in those without AFO (80.4% vs. 47.7%, P < 0.01); notably, 37.0% of patients with AFO developed cGVHD after AFO diagnosis. AFO patients developed BOS with a 5-year cumulative incidence of 49.1% after AFO onset. The 5-year cumulative incidence of non-relapse mortality in the AFO group was higher than that in the non-AFO group (24.7% vs. 7.1%, P < 0.01). These results suggest that closely monitoring PFTs within two years after allo-HSCT, regardless of cGVHD status, is important for early detection of AFO and prevention of progression to BOS. (192words).
在异体造血干细胞移植（allo-HSCT）后一年的肺功能测试（PFT）中，气流阻塞（AFO）的标准比美国国立卫生研究院的闭塞性细支气管炎综合征（BOS）标准更为严格。这项单中心回顾性队列研究评估了移植后任何时间 AFO 标准的临床影响。在 2006 年至 2016 年间接受 allo-HSCT 的 132 名患者中，AFO 的 2 年累积发生率为 35.0%，AFO 的中位诊断时间为移植后 101 天（范围 35-716 天）。AFO 患者的总体慢性移植物抗宿主病（cGVHD）发生率明显高于无 AFO 患者（80.4% vs. 47.7%，P<0.01）；值得注意的是，37.0%的 AFO 患者在 AFO 诊断后出现 cGVHD。AFO 患者在 AFO 发病后 5 年的 BOS 累积发生率为 49.1%。AFO 组的 5 年非复发死亡率累积发生率高于非 AFO 组（24.7% vs. 7.1%，P<0.01）。这些结果表明，无论 cGVHD 状态如何，在 allo-HSCT 后两年内密切监测 PFT 对于早期发现 AFO 并防止其进展为 BOS 非常重要。（192 个单词）。
