Bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (allo-HCT) is often diagnosed at a late stage when lung dysfunction is severe and irreversible. Identifying patients early after transplantation may offer improved strategies for early detection that could avert the morbidity and mortality of BOS. This study aimed to determine whether a decline in lung function before and early after (days +80 to +100) allo-HCT are associated with a risk of BOS beyond 6 months post-transplantation. In a single-center cohort of 2941 allo-HCT recipients, 186 (6%) met National Institutes of Health criteria for BOS. Pretransplantation and post-transplantation day +80 spirometric parameters were analyzed as continuous variables and included in a multivariable model with other factors, including donor source, graft source, conditioning regimen, use of total body irradiation, and immunoglobulin levels. Pre-transplantation forced expiratory flow between 25% and 75% of maximum (FEF25-75), day +80 forced expiratory volume in 1 second (FEV1), and day +80 FEF25-75 had the strongest associations with increased risk of BOS. Assessment of the multivariable model showed that a decline in day +80 FEF25-75 added additional risk to the day +80 FEV1 model (P = .03), whereas FEV1 decline at day +80 added no additional risk to the day +80 FEF25-75 model (P = .645). Moreover, day +80 FEF25-75 conferred additional risk when considered with pretransplantation FEF25-75. These results suggest that day +80 FEF25-75 may be more important than FEV1 in predicting the development of BOS. This study highlights the importance of obtaining early post-transplantation pulmonary function tests for the potential risk stratification of patients at risk for BOS.

中文翻译：

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异基因造血细胞移植后早期移植后肺活量测定与闭塞性细支气管炎综合征的发展有关。

异基因造血细胞移植（allo-HCT）后的闭塞性细支气管炎综合征（BOS）通常在肺功能障碍严重且不可逆转的晚期被诊断出来。在移植后早期识别患者可能会提供改进的早期检测策略，从而避免BOS的发病率和死亡率。这项研究旨在确定异基因HCT之前和之后（+80至+100天）肺功能下降是否与移植后6个月以上的BOS风险相关。在2941名同种HCT接受者的单中心队列中，有186名（6％）符合美国国立卫生研究院的BOS标准。移植前和移植后+80肺活量测定参数作为连续变量进行分析，并与其他因素一起纳入多变量模型，包括供体来源，移植物来源，调理方案，全身照射的使用和免疫球蛋白水平。移植前最大呼气量（FEF25-75）的25％至75％之间，第1天+80强制呼气量（FEV1），第80天FEF25-75与BOS风险增加之间的相关性最强。对多变量模型的评估表明，+ 80 FEF25-75天的下降为+80 FEV1模型增加了额外的风险（P = .03），而+80天的FEV1下降了+80 FEF25没有增加额外的风险-75模型（P = .645）。此外，与移植前FEF25-75一起考虑时，+ 80 FEF25-75天会带来额外的风险。这些结果表明，+ 80 FEF25-75天在预测BOS的发生中可能比FEV1更重要。