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The change of lung function in children with bronchiolitis obliterans syndrome after hematopoietic stem cell transplant
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  • Sungsu Jung,
  • Hee Mang Yoon,
  • Jisun Yoon,
  • Minjee Park,
  • Eun Sang Rhee,
  • Hyery Kim,
  • Kyung Nam Koh,
  • Jin Seong Lee,
  • Ho Joon Im,
  • Jinho Yu
Sungsu Jung
Pusan National University Yangsan Hospital
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Hee Mang Yoon
Asan Medical Center
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Jisun Yoon
Department of Pediatrics, Mediplex Sejong Hospital
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Minjee Park
Asan Medical Center
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Eun Sang Rhee
Asan Medical Center
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Hyery Kim
Asan Medical Center
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Kyung Nam Koh
Asan Medical Center
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Jin Seong Lee
Asan Medical Center
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Ho Joon Im
Asan Medical Center
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Jinho Yu
Asan Medical Center
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Abstract

Background: Bronchiolitis obliterans syndrome (BOS) is a life-threatening respiratory complication of allogeneic hematopoietic stem cell transplant (HSCT). Even though a lung function test is crucial in monitoring BOS, little information exists on the test’s association with prognosis in children with BOS. Objectives: The purpose of this study was to determine the correlation between changes in lung function after BOS diagnosis and long term outcomes. Methods: A total of 428 children received allogeneic HSCT from January 2006 to December 2017 at Asan Medical Center. Twenty-three of those children (5.4%) were diagnosed with BOS after allogeneic HSCT, and their clinical data were reviewed. Twenty-one subjects underwent regular pulmonary function tests for 24 months after the occurrence of BOS. Results: Among the 21 children with BOS, eight died, five underwent a lung transplant (TPL), and 15 required oxygen (O2) therapy. The FEV1% predicted (pred), FVC% pred, and FEF25-75% pred were 37.8±12.7% (mean±SD), 62.2±16.2%, and 16.4±9.6%, respectively, upon BOS diagnosis. Changes in the FEV1% pred were greater in the death and lung TPL group (-24.8±22.3%) than the survival without lung TPL group (5.7±21.8%), and greater in the O2 therapy (-19.4±23.4%) group than the group without O2 therapy (14.2±20.0%) during the first three months after BOS diagnosis. Conclusion: The change of FEV1 during the first three months after BOS correlated with the prognosis including survival, lung transplantation, and O2 therapy. These results suggest more active intervention in the first three months after BOS diagnosis may be needed to improve prognosis.

Peer review status:POSTED

10 Sep 2020Submitted to Pediatric Pulmonology
10 Sep 2020Assigned to Editor
10 Sep 2020Submission Checks Completed