Sadowska-Klasa Alicja, Karolak Wojciech, Piekarska Agnieszka, Kowalski Jacek, Żegleń Sławomir, Janowicz Alicja, Nadolny Tomasz, Wojarski Jacek, Zaucha Jan Maciej
Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland.
University Clinical Center, Gdańsk, Poland.
Respiration. 2025;104(4):264-271. doi: 10.1159/000542463. Epub 2024 Dec 2.
We investigated the incidence of chronic pulmonary complications in allogeneic hematopoietic cell transplantation (HCT) recipients and analyzed the role of transbronchial cryobiopsy (cryoTBB) as a tool to determine the nature of pulmonary changes and to guide clinical decisions.
Patients who survived at least 6 months post HCT were included in the study. Pulmonary functional tests (PFTs) were performed in all patients as a screening tool. In case of abnormal results computed tomography (CT) was done to verify inflammatory changes and the presence of air trapping. Next, patients were qualified for microbiological analysis of bronchoalveolar lavage fluid. If the results of noninvasive tests were inconclusive, cryoTBB was performed.
Among 186 patients, we identified 13 cases (7%) with abnormal PFTs. Mild, moderate, and severe chronic graft-versus-host disease (GvHD) was diagnosed in 1 (8%), 6 (46%), and 2 (15%) patients, respectively. Four (31%) patients did not present any manifestations of cGvHD at FEV1 decline. Eight 8 (62%) patients met the bronchiolitis obliterans syndrome criteria, 5 (48%) had restrictive disease, or mixed phenotype based on PFTs, only in 1 case air trapping was present in CT. Pulmonary GvHD was confirmed by cryoTBB histopathology in 5 of 11 (45%) cases. Immunosuppression was either stopped or decreased in 6 patients with negative results for GvHD with further clinical improvement.
CryoTBB can be a helpful tool to verify the cause of chronic pulmonary complications in the HCT population. Based on negative biopsy results, some patients may benefit from immunosupressive therapy discontinuation or reduction to mitigate recurrences of infectious complications and further lung destruction.
我们调查了异基因造血细胞移植（HCT）受者慢性肺部并发症的发生率，并分析了经支气管冷冻活检（cryoTBB）作为确定肺部变化性质和指导临床决策工具的作用。
本研究纳入了HCT后存活至少6个月的患者。对所有患者进行肺功能测试（PFT）作为筛查工具。若结果异常，则进行计算机断层扫描（CT）以验证炎症变化和气体陷闭的存在。接下来，患者接受支气管肺泡灌洗 fluid 的微生物学分析。若无创检查结果不明确，则进行 cryoTBB。
在186例患者中，我们确定了13例（7%）PFT异常的患者。分别有1例（8%）、6例（46%）和2例（15%）患者被诊断为轻度、中度和重度慢性移植物抗宿主病（GvHD）。4例（31%）患者在FEV1下降时未出现任何慢性移植物抗宿主病的表现。8例（62%）患者符合闭塞性细支气管炎综合征标准，5例（48%）有限制性疾病或基于PFT的混合表型，仅1例CT显示有气体陷闭。11例中有5例（45%）经cryoTBB组织病理学证实为肺部GvHD。6例GvHD结果为阴性的患者停止或减少了免疫抑制，临床进一步改善。
cryoTBB可以作为一种有用的工具来验证HCT人群中慢性肺部并发症的原因。基于活检结果为阴性，一些患者可能受益于停用或减少免疫抑制治疗，以减轻感染并发症的复发和进一步的肺破坏。
