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Bronchiolitis obliterans in bone marrow transplantation and its
relationship to chronic graft-v-host disease and low serum IgG
HK Holland, JR Wingard, WE Beschorner, R Saral and GW Santos
Oncology Center, Johns Hopkins University School of Medicine, Baltimore,
MD.
The records of 549 bone marrow transplant (BMT) patients at The Johns
Hopkins Oncology Center during a 9-year period were reviewed to determine
the incidence of bronchiolitis obliterans (BrOb). Seven patients had BrOb.
All seven died, and BrOb was a contributing cause of death in six patients.
Only recipients of allogeneic BMT were at risk for developing BrOb (2%
incidence). Three cases were incidentally discovered at autopsy in patients
who died less than 120 days after BMT from ventilatory failure owing to
interstitial pneumonitis. Four cases were patients who died greater than
120 days after BMT. Of this latter group, all had overt chronic
graft-v-host disease (CGVHD). Among 120 day survivors of allogeneic BMT, 6%
of those with CGVHD developed BrOb as compared with none of those without
CGVHD (P = .008). Five percent of patients with reduced IgG levels at day
120 developed BrOb as compared with none of those with normal IgG (P =
.04). The incidence of BrOb in 120-day survivors was 14% (4 of 29) in
patients with both CGVHD and decreased serum IgG, whereas patients with
CGVHD only (0 of 25), those with decreased IgG levels only (0 of 53), and
those with no CGVHD and normal IgG levels (0 of 70) did not develop BrOb.
Volume 72,
Issue 2,
pp. 621-627,
08/01/1988
Copyright © 1988 by The American Society of Hematology
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