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Updated: Jun 16, 2025
Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
Bronchiectasis after allogeneic hematopoietic cell transplantation - an underdiagnosed complication
Ophir Freund1, Yitzhac Hadad2, Anne Bergeron3
1The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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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