Bronchiectasis after allogeneic hematopoietic cell transplantation - an underdiagnosed complication

Area of Science:

• Hematology and Oncology
• Pulmonology
• Transplantation Medicine

Background:

• Bronchiectasis (BE) post-allogeneic hematopoietic cell transplantation (allo-HCT) is often associated with bronchiolitis obliterans syndrome (BOS).
• Limited data exists on the prevalence and characteristics of BE in allo-HCT recipients.

Purpose of the Study:

• To determine the prevalence, clinical features, and outcomes of new-onset, symptomatic bronchiectasis (BE) following allo-HCT.
• To identify risk factors and mortality associated with BE after allo-HCT.

Main Methods:

• Prospective analysis of a cohort undergoing allo-HCT between 2014-2022.
• Chest CT scans of symptomatic patients were reviewed for BE, comparing pre- and post-transplant findings.
• Pulmonary function tests (PFTs) and mortality rates were compared between patients with and without BE.

Main Results:

• 20% (36/182) of eligible allo-HCT survivors developed new-onset BE.
• Independent predictors for BE included chronic graft-versus-host disease and lower baseline FEV1.
• BE was associated with a nearly twofold increased hazard of mortality, further elevated in patients meeting BOS criteria.

Conclusions:

• Bronchiectasis is a common and significant complication after allo-HCT.
• The impact of BE on outcomes is substantial and not fully explained by co-existing BOS.