Table 1.
Clinical characteristics and pulmonary function tests at the time of allo-HCT.
| BuCy | FluBu4 | TBF MAC | p value | |
|---|---|---|---|---|
| N | 175 | 29 | 37 | |
| Patient sex (% of male) | 99 (57) | 16 (55) | 19 (51) | 0.84 |
| Donor sex (% of male) | 101 (58) | 20 (69) | 18 (49) | 0.25 |
| Age at allo-HCT, median (range) | 43 (18, 58) | 46 (26, 59) | 39 (19, 59) | 0.08 |
| KPS, median (range) | 90 (30, 100) | 90 (30, 100) | 90 (70, 100) | 0.77 |
| Median follow up in months (range) | 65 (3, 275) | 62 (2, 107) | 40.3 (2, 100) | 0.001 |
| Donors, n (%) | ||||
| - related | 61 (35) | 9 (31) | 10 (27) | 0.63 |
| - unrelated | 114 (65) | 20 (69) | 27 (73) | |
| GvHD prophylaxis, n (%) | ||||
| - without in vivo TCD | 65 (37) | 12 (41) | 8 (22) | 8 (22) |
| - with in vivo TCD | 110 (63) | 17 (59) | 29 (78) | 0.15 |
| Type of GvHD prophylaxis, n (%) | ||||
| - CyA/ATG | 72 (41) | 17 (59) | 29 (78) | 0.001 |
| - CyA/alemtuzumab | 38 (22) | 0 | 0 | |
| Lung disease before allo-HCT, n (%) | 74 (42) | 1 (4) | 7 (19) | 0.001 |
| - fungal pneumonia or aspergillosis | 31 | 1 | 1 | |
| - bact. pneumonia | 15 | 0 | 2 | |
| - bronchitis or upper airway infection | 11 | 0 | 0 | |
| - COPD/Asthma | 8 | 0 | 0 | |
| - atypical pneumonia | 3 | 0 | 1 | |
| - viral pneumonia | 2 | 0 | 1 | |
| - pleura effusions | 4 | 0 | 0 | |
| - pulmonary embolism | 4 | 0 | 0 | |
| - others (leukemia infiltration, pleuritis, aspiration pneumonia, interstitielle pneumonia, lung edema, restrictive lung disease) | 4 | 0 | 2 | |
| Lung disease up to 100 d after allo-HCT, n (%) | 49 (28) | 5 (17) | 7 (19) | 0.29 |
| - bact. pneumonia | 21 | 0 | 2 | |
| - fungal pneumonia or aspergillosis | 12 | 2 | 3 | |
| - obstructive lung function | 7 | 0 | 0 | |
| - viral pneumonia | 4 | 1 | 1 | |
| - bronchitis or upper airway infection | 4 | 1 | 0 | |
| - pleura effusions | 5 | 0 | 1 | |
| - others (engraftment syndrome, atypical pneumonia) | 8 | 1 | 0 | |
| Smoking current or previous (%) | 53 (30) | 3 (10) | 2 (5) | 0.001 |
| Pulmonary function tests before allo-HCT, median (range) | ||||
| - FEV1 (% predicted) | 98 (44, 142) | 99 (70, 133) | 98 (67, 127) | 0.88 |
| - FEV1/FVC ratio | 0.83 (0.55, 1.00) | 0.82 (0.66, 0.95) | 0.84 (0.67, 1.13) | 0.75 |
| - MEF50 (% predicted) | 70 (4, 159) | 81 (5, 130) | 82 (44, 147) | 0.07 |
| - MEF25 (% of predicted) | 45 (11, 122) | 57 (2, 124) | 53 (18, 242) | 0.003 |
| - DLCOc SB (% predicted) | 76 (46, 109) | 74 (52, 108) | 76 (40, 1.04) | 0.63 |
| - RV (% predicted) | 111 (42, 223) | 107 (64, 153) | 103 (55, 148) | 0.18 |
| - RV/TLC ratio | 0.33 (0.14, 1.18) | 0.34 (0.19, 0.49) | 0.30 (16, 108) | 0.18 |
| - TLC (% predicted) | 96 (51, 131) | 96 (79, 130) | 97 (65, 133) | 0.17 |
| - aCO2 (mmHg) | 37 (27, 46) | 36 (30, 44) | 37 (28, 42) | 0.15 |
| - aO2 (mmHg) | 83 (65, 103) | 84 (67, 92) | 85 (66, 106) | 0.005 |
| Time from allo-HCT to BOS diagnosis in months, median (range) | 12.5 (2.4, 111.3) | 8.91 (3.6, 14.2) | 13.6 (5.5, 30.4) | 0.75 |
| Cumulative incidence of BOS after allo-HCT, % (95% CI) at | 0.07 | |||
| - 1 year | 11.9 (7.7, 18.3) | 3.6 (0.5, 22.7) | 9.3 (3.1, 26.1) | |
| - 2 year | 23.2 (17.0, 31.1) | 8.4 (2.1, 30.1) | 19.5 (9.2, 38.6) | |
| - 3 year | 30.2 (23.1, 38.9) | 8.4 (2.1, 30.1) | 23.4 (11.0, 43.1) | |
| - 5 year | 31.2 (23.9, 39.9) | 8.4 (2.1, 20.1) | 23.4 (11.0, 43.1) | |
| BOS severity, n (%) | ||||
| - Mild (FEV1 60-79%) | 12 (26) | – | (28) | |
| - Moderate (FEV1 40-59%) | 21 (47) | 2 (100) | (57) | |
| - Severe (FEV1 ≤ 39%) | 12 (26) | – | 1 (14) | |
Allo-HCT allogeneic hematopoietic cell transplantation, KPS Karnofsky performance score, GvHD graft-versus-host disease, TCD T-cell depletion, CyA cyclosporine A, ATG antithymocyte globuline, COPD chronic obstructive pulmonary disease, bact. bacterial, BOS bronchiolitis obliterans syndrome, FEV1 forced expiratory volume in 1 s (FEV1), FVC forced vital capacity, RV residual volume, TLC total lung capacity, MEF50 mid-expiratory flow 50%, MEF25 mid-expiratory flow 25%, DLCOc SB carbon monoxide diffusion capacity corrected for hemoglobin, BuCy Busulfan/Cyclophosphamide, FluBu4 Fludarabine/Busulfan 4 days, TBF MAC Thiotepa/Busulfan/Fludarabine myeloablative conditioning.