Highlights
- •Bronchiolitis obliterans syndrome may complicate bone marrow transplantation.
- •Quantitative chest CT facilitates diagnosis of BOS in children.
- •Low-attenuation lung volume is associated with severity of airway obstruction.
Abstract
Objectives
Bronchiolitis obliterans syndrome (BOS) diagnosis in children following allogeneic
hematopoietic stem cell transplantation (post-HSCT) is based on detection of airway
obstruction on spirometry and air-trapping, small airway thickening or bronchiectasis
on chest CT. We assessed the relationship between spirometry indices and low-attenuation
lung volume at total lung capacity (TLC) on CT.
Methods
Data of children post-HSCT with and without BOS were analyzed. An age-specific, low-attenuation
threshold (LAT) was defined as average of (mean-1SD) lung parenchyma attenuation of
5 control subjects without lung disease matched to each age subgroup of post-HSCT
patients. % CT lung volume at TLC with attenuation values <LAT was calculated. Association
between % lung volume with low attenuation and FEV1/FVC was assessed.
Results
Twenty-nine children post-HSCT were referred to exclude BOS and 12 of them had spirometry
and an analyzable chest CT. We studied: (i) 6 children post-HSCT/BOS (median age:
8.5 years [IQR 7, 15]; median FEV1/FVC z-score: -2.60 [IQR -2.93, −2.14]); (ii) 6 children post-HSCT/no BOS (age: 13.5 years
[9.8, 16.3]; FEV1/FVC z-score: 0.44 [−0.30, 2.10]); and (iii) 40 controls without lung disease (age:11 years
[8.3, 15.8]). Patients post-HSCT/BOS had significantly higher % lung volume with low
attenuation than patients post-HSCT/no BOS: median % volume 16.4% (7.1%, 37.2%) vs.
0.61% (0.34%, 2.79%), respectively; P = .004. An exponential model described the association
between % CT lung volume below LAT and FEV1/FVC z-score (r2 = 0.76; P < .001).
Conclusion
In children post-HSCT with BOS, low-attenuation lung volume on chest CT is associated
with airway obstruction severity as expressed by FEV1/FVC z-score.
Keywords
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References
- Quantitative assessment of chronic lung disease of infancy using computed tomography.Eur Respir J. 2012; 39: 992-999
- Quantitative CT scans of lung parenchymal pathology in premature infants ages 0-6 years.Pediatr Pulmonol. 2018; 53: 316-323
- Chest imaging in cystic fibrosis studies: what counts, and can be counted?.J Cyst Fibros. 2017; 16: 175-185
- Lung clearance index and quantitative computed tomography of post-infectious bronchiolitis obliterans in infants.Sci Rep. 2017; 7: 15128
- Quantification of neonatal lung parenchymal density via ultrashort echo time MRI with comparison to CT.J Magn Reson Imaging. 2017; 46: 992-1000
- Xenon-129 MRI detects ventilation deficits in paediatric stem cell transplant patients unable to perform spirometry.Eur Respir J. 2019; : 53(5)
- Quantitative magnetic resonance imaging of bronchopulmonary dysplasia in the neonatal intensive care unit environment.Am J Respir Crit Care Med. 2015; 192: 1215-1222
- Assessment of early lung disease in young children with CF: a comparison between pressure-controlled and free-breathing chest computed tomography.Pediatr Pulmonol. 2020; 55: 1161-1168
- Biopsy-verified bronchiolitis obliterans and other noninfectious lung pathologies after allogeneic hematopoietic stem cell transplantation.Biol Blood Marrow Transplant. 2015; 21: 531-538
- Imatinib melylate as second-line treatment of bronchiolitis obliterans after allogenic hematopoietic stem cell transplantation in children.Pediatr Pulmonol. 2020; 55: 631-637
- How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.Blood. 2017; 129: 448-455
- Fluticasone, azithromycin, and montelukast treatment for new-onset bronchiolitis obliterans syndrome after hematopoietic cell transplantation.Biol Blood Marrow Transplant. 2016; 22: 710-716
- Screening with spirometry is a useful predictor of later development of noninfectious pulmonary syndromes in patients undergoing allogeneic stem cell transplantation.Biol Blood Marrow Transplant. 2014; 20: 781-786
- Value of screening spirometry for early diagnosis of bronchiolitis obliterans syndrome in children after allogeneic hematopoietic stem cell transplantation.J Pediatr Hematol Oncol. 2015; 37: e462-e467
- Lung histology predicts outcome of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.Biol Blood Marrow Transplant. 2013; 19: 973-980
- High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.J Thorac Imaging. 2008; 23: 244-250
- Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria.Blood. 2019; 134: 304-316
- National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. the 2014 diagnosis and staging working group report.Biol Blood Marrow Transplant. 2015; 21 ([e1]): 389-401
- Machine learning algorithms utilizing quantitative CT features may predict eventual onset of bronchiolitis obliterans syndrome after lung transplantation.Acad Radiol. 2018; 25: 1201-1212
- Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation.Lancet Haematol. 2020; 7: e157-e167
- Lung densitometry: why, how and when.J Thorac Dis. 2017; 9: 3319-3345
- Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial.Eur Radiol. 2009; 19: 58-66
- Quantitative computed tomography assessment of graft-versus-host disease-related bronchiolitis obliterans in children: a pilot feasibility study.Eur Radiol. 2015; 25: 2931-2936
- Evaluating for bronchiolitis obliterans with low-attenuation computed tomography three-dimensional reconstructions.Am J Respir Crit Care Med. 2018; 197: 814-815
- Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations.Eur Respir J. 2012; 40: 1324-1343
- Interpretative consequences of adopting the global lungs 2012 reference equations for spirometry for children and adolescents.Pediatr Pulmonol. 2014; 49: 118-125
- Budesonide/formoterol for bronchiolitis obliterans after hematopoietic stem cell transplantation.Am J Respir Crit Care Med. 2015; 191: 1242-1249
- Automated CT scan scores of bronchiectasis and air trapping in cystic fibrosis.Chest. 2014; 145: 593-603
- Lung evaluation in 10 year survivors of pediatric allogeneic hematopoietic stem cell transplantation.Eur J Pediatr. 2019; 178: 1833-1839
- Pulmonary clinicopathological correlation after allogeneic hematopoietic stem cell transplantation: an autopsy series.Biol Blood Marrow Transplant. 2017; 23: 1767-1772
- Multicenter evaluation of parametric response mapping as an indicator of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.Am J Transplant. 2020; 20: 2198-2205
- Parametric response mapping as an indicator of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.Biol Blood Marrow Transplant. 2014; 20: 1592-1598
- Quantitative CT characterization of pediatric lung development using routine clinical imaging.Pediatr Radiol. 2016; 46: 1804-1812
- Postinfectious bronchiolitis obliterans in children: the south American contribution.Acta Paediatr. 2014; 103: 913-921
- CT densitovolumetry in children with obliterative bronchiolitis: correlation with clinical scores and pulmonary function test results.J Bras Pneumol. 2013; 39: 701-710
- Comparison of the sensitivities of 5 different computed tomography scanners for the assessment of the progression of pulmonary emphysema: a phantom study.Invest Radiol. 2004; 39: 1-7
- Quantitative thoracic CT techniques in adults: can they be applied in the pediatric population?.Pediatr Radiol. 2013; 43: 308-314
- Lung function reference values in Chinese children and adolescents in Hong Kong. I. Spirometric values and comparison with other populations.Am J Respir Crit Care Med. 2000; 162: 424-429
Article info
Publication history
Published online: January 21, 2021
Accepted:
January 11,
2021
Received in revised form:
December 21,
2020
Received:
June 3,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
