소아청소년 환자에서의 동종조혈모세포이식 후 발생한 폐쇄성세기관지염증후군의 임상적 특성

Abstract

Background: Bronchiolitis obliterans syndrome (BOS) is a life-threatening lung complication after allogenic hematopoietic stem cell transplantation (HSCT). As long-term survival following allogenic HSCT has improved, the number of BOS patients has been steadily increased. However, the survival and treatment of BOS have not improved significantly for decades. Identification of risk factors of BOS would improve the clinical outcome of allogenic HSCT recipients.Methods: We retrospectively investigated medical records of 147 allogenic HSCT recipients between 2005 and 2014 in Yonsei Cancer Center. Risk factors for BOS were analyzed with Chi-square test, logistic regression analysis, and the Student’s t-test.Results: BOS occurred to 23 patients (15.6%). Pulmonary function test (PFT) results before transplantation were similar in all patients, but patients with BOS had a significant decrease in forced expiratory volume in one second (FEV1) after transplantation compared with controls (68.4±26.4% vs. 91.6±21.0%, P＜0.05). Acute graft-versus-host disease (GVHD) (OR 5.98, P=0.009) and peripheral blood as sources of stem cell (OR 4.00, P=0.031) increased risk for BOS, respectively. On the other hand, previously reported risk factors, such as age of donors and recipients, pulmonary infection within 100 days after allogenic HSCT and deference of immunosuppressant were not associated with increased the incidence of BOS in our study.Conclusion: We report here the result of a single-center study on the incidence, clinical factors, and outcome of BOS after allogenic HSCT. BOS is an important cause of post-transplantation morbidity and mortality. Risk reduction can be achieved by better prevention and control of BOS.