Bronchiolitis Obliterans

Bronchiolitis obliterans is a small-airway injury syndrome characterized pathologically by bronchiolar inflammation and fibrosis that narrows or obliterates terminal airways, producing progressive airflow obstruction. Airway epithelial injury and chronic intrapulmonary inflammation are implicated in environmental and occupational disease. The Lancet+1The LancetEnvironmental and occupational bronchiolitis obliteransScienceDirectPrevalence of Bronchiolitis Obliterans Syndrome (BOS) Following Allogeneic Hematopoietic Stem Cell Transplant (alloHSCT) in the USA, Europe and Japan - ScienceDirect

In transplant practice, bronchiolitis obliterans syndrome (BOS) is a clinical syndrome defined by airflow obstruction rather than a requirement for surgical-pathologic confirmation. It occurs after lung transplantation and after allogeneic hematopoietic stem-cell transplantation (HSCT), where it is a pulmonary manifestation of chronic graft-versus-host disease (cGVHD). JAMA+3JAMAEffect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant:NatureBronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosisScienceDirectBronchiolitis obliterans syndrome is not specific for ...ScienceDirectPrevalence of Bronchiolitis Obliterans Syndrome (BOS) Following Allogeneic Hematopoietic Stem Cell Transplant (alloHSCT) in the USA, Europe and Japan - ScienceDirect

Keep post-HSCT BOS distinct from the pediatric acute viral bronchiolitis guideline literature, which addresses a different disease and does not inform BOS treatment. pediatrics aappublicationspediatrics aappublicationsClinical Practice Guideline: The Diagnosis, Management ...

In allogeneic HSCT recipients, obtain and trend spirometry because an FEV1 decrease may occur before overt obstructive lung disease. New cough, dyspnea, increased oxygen requirement, a reduced pulmonary-function result, or abnormal high-resolution CT findings should prompt focused evaluation. JAMA+1JAMAEffect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant:ScienceDirectBiopsy-Verified Bronchiolitis Obliterans and Other ...

Pediatric guidance consistently endorses pulmonary-function-test surveillance after HSCT, although reported recommended intervals range from every 3 months to annually during the first post-transplant year. This heterogeneity supports using the responsible transplant program's surveillance pathway rather than assuming a universally established interval. Oxford AcademicOxford AcademicDetection of Bronchiolitis Obliterans Syndrome after Pediatric ...

Children must be able to perform reproducible pulmonary function testing for BOS criteria to be applicable; this is generally feasible after approximately age 5 years. ScienceDirectScienceDirectBronchiolitis Obliterans - an overview

For post-HSCT disease, the defining clinical signal is new obstructive lung disease on pulmonary function testing in the appropriate transplant and cGVHD context. For lung allograft recipients, BOS remains a spirometry-based clinical entity within obstructive chronic lung allograft dysfunction. JAMA+3JAMAEffect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant:NatureBronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosisWolters KluwerQuantitative Image Analysis at Chronic Lung...ScienceDirectBronchiolitis obliterans syndrome is not specific for ...

The supplied sources do not provide sufficiently detailed consensus thresholds for FEV1, FEV1/FVC, residual volume, or imaging criteria. Avoid applying uncited numeric cutoffs from memory when using this evidence set; use current transplant-specific consensus criteria and interpret results against the patient's baseline. ASH+1ASHHow I treat bronchiolitis obliterans syndrome after ...clinicaltrialsStudy Details | NCT03674047 | Ruxolitinib for Bronchiolitis Obliterans Syndrome (BOS) After Allogeneic Hematopoietic Cell Transplantation (HCT) | ClinicalTrials.gov

Do not equate an obstructive spirometric pattern automatically with BOS. Infection, acute allograft or airway processes, medication effects, and alternative structural or parenchymal disease require assessment in the relevant transplant context. This is especially important because symptoms, oxygen requirement, pulmonary-function decline, and HRCT abnormalities have all been used to select patients for lung biopsy in published post-HSCT cohorts. ScienceDirectScienceDirectBiopsy-Verified Bronchiolitis Obliterans and Other ...

Established BOS after HSCT is generally considered irreversible despite immunosuppressive therapy. Treatment should therefore prioritize confirmation of the phenotype, evaluation for remediable competing processes, control of associated cGVHD, serial pulmonary-function assessment, and specialist-directed optimization of immunosuppression and supportive care. JAMA+2JAMAEffect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant:ASHHow I treat bronchiolitis obliterans syndrome after ...clinicaltrialsStudy Details | NCT03674047 | Ruxolitinib for Bronchiolitis Obliterans Syndrome (BOS) After Allogeneic Hematopoietic Cell Transplantation (HCT) | ClinicalTrials.gov

Systemic glucocorticoids were endorsed as first-line systemic treatment in an earlier consensus discussion, but the available search results also emphasize poor response to corticosteroids or immunosuppressants and the absence of established treatment approaches. This tension reflects limited and evolving evidence rather than a reliably effective reversal strategy. Nature+1NatureWhat we know and mostly do not know about bronchiolitis ...journal chestnetTamibarotene for the Treatment of Bronchiolitis Obliterans ...

For adult pulmonary cGVHD, use the 2024 ERS/EBMT clinical practice guideline as the current guideline anchor and coordinate decisions with the transplant center. The supplied excerpts do not provide its specific recommendations, agent selection, or dosing; these should not be reconstructed from the citations here. clinicaltrialsclinicaltrialsStudy Details | NCT03674047 | Ruxolitinib for Bronchiolitis Obliterans Syndrome (BOS) After Allogeneic Hematopoietic Cell Transplantation (HCT) | ClinicalTrials.gov

After allogeneic HSCT, BOS has been reported in 4% to 6% of recipients overall and in up to 14% of those with cGVHD. It usually develops within 2 years after transplantation. JAMAJAMAEffect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant:

A pediatric HSCT trial description cites approximately 40% to 60% mortality and 13% 5-year survival once BOS is diagnosed; these estimates should be communicated cautiously because they derive from a trial background summary rather than a contemporary comparative cohort. clinicaltrialsclinicaltrialsStudy Details | NCT03072849 | Early Detection and Management of Bronchiolitis Obliterans Syndrome Following Pediatric Hematopoietic Stem Cell Transplantation | ClinicalTrials.gov

The key prognostic consequence is that airflow obstruction is often progressive and difficult to reverse. This supports active surveillance, early review of FEV1 decline, and timely transplant-center involvement rather than waiting for severe symptomatic limitation. JAMA+1JAMAEffect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant:ASHHow I treat bronchiolitis obliterans syndrome after ...