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Obliterative bronchiolitis complicating bone marrow transplantation.

Theodore K Marras1, Charles K N Chan

  • 1University of Toronto, Division of Respiratory Medicine, Ontario, Canada. ted.marras@utoronto.ca

Seminars in Respiratory and Critical Care Medicine
|August 10, 2005
PubMed
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Obliterative bronchiolitis (OB) is a common, severe respiratory complication after allogeneic bone marrow transplant, often fatal despite treatment. Early detection and immunosuppression may improve outcomes for this obstructive airways disease.

Area of Science:

  • Medicine
  • Immunology
  • Pulmonology

Background:

  • Respiratory complications are a major cause of death after bone marrow transplantation.
  • Obliterative bronchiolitis (OB) is the most frequent noninfectious respiratory complication, occurring in 9% of allogeneic transplant recipients.
  • OB is rare after autologous transplant due to the absence of chronic graft-versus-host disease.

Purpose of the Study:

  • To describe the characteristics, diagnosis, and treatment of obliterative bronchiolitis (OB) following bone marrow transplantation.
  • To highlight the role of alloreactive immunity and T-helper type 2 (TH2) lymphocytes in OB pathogenesis.
  • To emphasize the poor prognosis and potential for improved outcomes with early intervention.

Main Methods:

  • Literature review and synthesis of clinical data on OB post-bone marrow transplant.

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  • Analysis of diagnostic findings including imaging (HRCT) and pulmonary function tests.
  • Review of treatment strategies, primarily corticosteroids, and their efficacy.

    • Main Results:

    • OB typically presents 6-12 months post-transplant with cough and dyspnea.
    • Diagnostic findings include characteristic HRCT abnormalities and fixed airflow obstruction.
    • Histology shows bronchiolar inflammation, fibrosis, and obliteration.
    • Treatment with corticosteroids is often prolonged (3-9 months) with generally poor response.

    Conclusions:

    • Obliterative bronchiolitis (OB) is a serious complication of allogeneic bone marrow transplant with high mortality (40-100%) and frequent permanent respiratory impairment.
    • Current treatments have limited efficacy, underscoring the need for early detection and prompt immunosuppression.
    • Alloreactive immunity, mediated by TH2 lymphocytes, is implicated in OB development.