Summary:
Bronchiolitis obliterans (BO) is a rare but serious complication of paediatric allogenic bone marrow transplantation (BMT). Currently, there is no clear evidence that therapeutic interventions have a positive impact on the course of the disease. We here report our experience with high-dose pulse methylprednisolone therapy in children after BMT. Nine patients fulfilling clinical and radiologic signs of BO were included in this analysis. The total amount of treatment cycles with pulse methylprednisolone therapy ranged from 1 to 6 cycles (median four cycles). Oxygen saturation increased significantly with normalization of oxygen saturation at the end of therapy in all individuals. Normal oxygen saturation was maintained in all but one patient during follow-up (mean follow-up period 42 {plus/minus} 20 months, range 19–67 months). Forced expiratory volume in 1 s (FEV1) was within the normal range prior BMT and significantly diminished at the time of BO diagnosis. Treatment led to stabilization of lung function, with a significant improvement of FEV1 after 2 months. In all, 7/9 patients remained in clinically stable condition without further deterioration of lung function during follow-up. These data would suggest that anti-inflammatory therapy may be a valuable treatment option in paediatric patients with bronchiolitis obliterans after BMT.
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References
Palmas A, Tefferi A, Myers JL et al. Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation. Br J Haematol 1998; 100: 680–687.
Duncker C, Dohr D, Harsdorf S et al. Non-infectious lung complications are closely associated with chronic graft-versus-host disease: a single center study of incidence, risk factors and outcome. Bone Marrow Transplant 2000; 25: 1263–1268.
Griese M, Rampf U, Hofmann D et al. Pulmonary complications after bone marrow transplantation in children: twenty-four years of experience in a single pediatric center. Pediatr Pulmonol 2000; 30: 393–401.
Patriarca F, Skert C, Sperotto A et al. Incidence, outcome, and risk factors of late-onset noninfectious pulmonary complications after unrelated donor stem cell transplantation. Bone Marrow Transplant 2004; 33: 751–758.
Ostrow D, Buskard N, Hill RS et al. Bronchiolitis obliterans complicating bone marrow transplantation. Chest 1985; 87: 828–830.
Clark JG, Crawford SW, Madtes DK et al. Obstructive lung disease after allogeneic marrow transplantation. Clinical presentation and course. Ann Intern Med 1989; 111: 368–376.
Schwarer AP, Hughes JM, Trotman-Dickenson B et al. A chronic pulmonary syndrome associated with graft-versus-host disease after allogeneic marrow transplantation. Transplantation 1992; 54: 1002–1008.
Schultz KR, Green GJ, Wensley D et al. Obstructive lung disease in children after allogeneic bone marrow transplantation. Blood 1994; 84: 3212–3220.
Philit F, Wiesendanger T, Archimbaud E et al. Post-transplant obstructive lung disease (‘bronchiolitis obliterans’): a clinical comparative study of bone marrow and lung transplant patients. Eur Respir J 1995; 8: 551–558.
Trisolini R, Bandini G, Stanzani M et al. Morphologic changes leading to bronchiolitis obliterans in a patient with delayed non-infectious lung disease after allogeneic bone marrow transplantation. Bone Marrow Transplant 2001; 28: 1167–1170.
Jaramillo A, Fernandez FG, Kuo EY et al. Immune mechanisms in the pathogenesis of bronchiolitis obliterans syndrome after lung transplantation. Pediatr Transplant 2005; 9: 84–93.
Cooper JD, Billingham M, Egan T et al. A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allograft. International Society for Heart and Lung Transplantation. J Heart Lung Transplant 1993; 12: 713–716.
Rajagopalan N, Maurer J, Kesten S . Bronchodilator response at low lung volumes predicts bronchiolitis obliterans in lung transplant recipients. Chest 1996; 109: 405–407.
Marras TK, Szalai JP, Chan CK et al. Pulmonary function abnormalities after allogeneic marrow transplantation: a systematic review and assessment of an existing predictive instrument. Bone Marrow Transplant 2002; 30: 599–607.
Marras TK, Chan CK, Lipton JH et al. Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation. Bone Marrow Transplant 2004; 33: 509–517.
Worthy SA, Flint JD, Muller NL . Pulmonary complications after bone marrow transplantation: high-resolution CT and pathologic findings. Radiographics 1997; 17: 1359–1371.
Ooi GC, Peh WC, Ip M . High-resolution computed tomography of bronchiolitis obliterans syndrome after bone marrow transplantation. Respiration 1998; 65: 187–191.
Jung JI, Jung WS, Hahn ST et al. Bronchiolitis obliterans after allogenic bone marrow transplantation: HRCT findings. Korean J Radiol 2004; 5: 107–113.
Dudek AZ, Mahaseth H, DeFor TE et al. Bronchiolitis obliterans in chronic graft-versus-host disease: analysis of risk factors and treatment outcomes. Biol Blood Marrow Transplant 2003; 9: 657–666.
Fleisher GR, Ludwig S (eds). Textbook of Pediatric Emergency Medicine, 3rd edn. Williams and Wilkins: Baltimore, MD, 1993.
Rabitsch W, Deviatko E, Keil F et al. Successful lung transplantation for bronchiolitis obliterans after allogeneic marrow transplantation. Transplantation 2001; 71: 1341–1343.
Clement A . ERS Task Force. Task force on chronic interstitial lung disease in immunocompetent children. Eur Respir J 2004; 24: 686–697.
Kudoh S . Applying lessons learned in the treatment of diffuse panbronchiolitis to other chronic inflammatory diseases. Am J Med 2004; 117: 12S–19S.
Gerhardt SG, McDyer JF, Girgis RE et al. Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study. Am J Respir Crit Care Med 2003; 168: 121–125.
Ishii T, Manabe A, Ebihara Y et al. Improvement in bronchiolitis obliterans organizing pneumonia in a child after allogeneic bone marrow transplantation by a combination of oral prednisolone and low dose erythromycin. Bone Marrow Transplant 2000; 26: 907–910.
Siddiqui J . Immunomodulatory effects of macrolides: implications for practicing clinicians. Am J Med 2004; 117: 26S–29S.
Blanco D . Breathing new life into home care. Texas hospital remotely monitors the pulmonary function of post-transplant pediatric patients. Health Manag Technol 2004; 25: 38–40.
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Ratjen, F., Rjabko, O. & Kremens, B. High-dose corticosteroid therapy for bronchiolitis obliterans after bone marrow transplantation in children. Bone Marrow Transplant 36, 135–138 (2005). https://doi.org/10.1038/sj.bmt.1705026
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DOI: https://doi.org/10.1038/sj.bmt.1705026
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