异基因造血细胞移植后支气管扩张-一种未被诊断的并发症

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine Pub Date : 2025-06-11 DOI:10.1016/j.rmed.2025.108208

Ophir Freund , Yitzhac Hadad , Anne Bergeron , Sabrina Fried , Gidon Pomerantz , Avshalom Shaffer , Dolev Paz , Nevo Barel , Tal Moshe Perluk , Odelia Amit , Ron Ram , Amir Bar-Shai

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引用次数: 0

摘要

背景：同种异体造血细胞移植（alloo - hct）后的支气管扩张（BE）在闭塞性细支气管炎综合征（BOS）的背景下被描述。然而，关于其在同种异体hct患者中的总体患病率和特征的数据很少。目的评估同种异体hct术后新发症状性支气管扩张的患病率、特点和预后。方法采用前瞻性数据库，纳入2014年至2022年在三级中心接受allo-HCT治疗的所有受试者。对有呼吸道症状的受试者的胸部CT扫描进行分析，并与hct前的BE扫描进行比较。比较了BE和非BE患者肺功能测试（PFTs）和死亡率的变化。结果282例患者接受了同种异体hct治疗，182例患者在6个月时存活。36例（20%）被诊断为新发BE。从HCT到BE诊断的中位（IQR）持续时间为304（202-547）天。在有BE和连续pft的患者中，39%符合BOS的标准。BE的独立预测因子包括慢性移植物抗宿主病（调整OR为6.8,95% CI 1.34-34.6）和较低的基线FEV1 % （aOR为0.95,95% CI 0.92-0.98）。扩展cox模型和亚组分析证实，BE与死亡风险增加相关（HR 1.91, 95% CI 1.1-3.6）。符合BOS标准的患者随访pft较低，支气管扩张弥漫性分布率较高（67%对32%）。此外，与不符合这些标准的BE相比，BOS患者的死亡率更高（HR 3.40, 95% CI 1.2-9.4）。结论同种异体hct后支气管扩张普遍存在，影响重大，不能完全由BOS解释。

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Bronchiectasis after allogeneic hematopoietic cell transplantation – an underdiagnosed complication

Background

Bronchiectasis (BE) following allogeneic hematopoietic cell transplantation (allo-HCT) are described in the context of bronchiolitis obliterans syndrome (BOS). However, data on its overall prevalence and characteristics in allo-HCT patients are scarce.

Objectives

To assess the prevalence, characteristics, and outcomes of symptomatic new-onset bronchiectasis after allo-HCT.

Methods

A prospective database with all subjects that underwent allo-HCT between 2014 and 2022 in a tertiary center was utilized. Chest CT scans of subjects with respiratory symptoms were analyzed and compared to pre-HCT scans for BE. Changes in pulmonary function tests (PFTs) and mortality were compared between patients with and without BE.

Results

Overall, 282 subjects underwent allo-HCT and 182 survived at 6 months. Thirty-six patients (20 %) were diagnosed with new-onset BE. Median (IQR) duration from HCT to BE diagnosis was 304 (202–547) days. Of those with BE and serial PFTs, 39 % met the criteria for BOS. Independent predictors for BE included chronic graft vs. host disease (adjusted OR 6.8, 95 % CI 1.34–34.6) and a lower baseline FEV1 % (aOR 0.95, 95 % CI 0.92–0.98). BE was associated with increased hazard of mortality (HR 1.91, 95 % CI 1.1–3.6), validated by an extended cox model and sub-group analyses. Patients meeting the criteria for BOS had lower follow-up PFTs and a higher rate of diffuse distribution of bronchiectasis (67 % vs. 32 %). Moreover, patients with BOS had increased mortality compared to BE not meeting these criteria (HR 3.40, 95 % CI 1.2–9.4).

Conclusions

Bronchiectasis is prevalent after allo-HCT with major impact, not solely explained by BOS.

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来源期刊

Respiratory medicine 医学-呼吸系统

CiteScore

7.50

自引率

0.00%

发文量

199

审稿时长

38 days

期刊介绍： Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.