Clinical analysis of 7 children with bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation
10.3760/cma.j.cn101070-20210202-00144
- VernacularTitle:儿童造血干细胞移植后闭塞性细支气管炎综合征7例临床分析
- Author:
Hongliang YOU
1
;
Yanjie DING
;
Jiao CHEN
;
Huanhuan LI
;
Yufeng LIU
;
Dao WANG
Author Information
1. 郑州大学第一附属医院儿童医院血液肿瘤科，郑州 450052
- Keywords:
Hematopoietic stem cell transplantation;
Bronchiolitis obliterans syndrome;
Child
- From:
Chinese Journal of Applied Clinical Pediatrics
2022;37(10):774-777
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical characteristics and treatment of bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation (HSCT) in children.Methods:Clinical data of 7 patients with BOS after HSCT in the Department of Hematology and Oncology, Children′s Hospital, the First Affiliated Hospital of Zhengzhou University from September 2015 to June 2019, who had a survival of longer than 100 days were retrospectively analyzed.Results:At the last follow-up visit, the incidence of BOS was 4.6%(7/152 cases), including 5 males and 2 females.The median time from HSCT to the diagnosis of BOS was 15 (9-27) months.Among the 7 cases, 5 cases had dry cough and shortness of breath after activity, and 2 cases had no obvious clinical symptoms.Pulmonary function was moderate in 5 cases and severe in 2 cases of obstructive ventilatory disorder.High-resolution CT showed mosaic sign in 5 cases and bronchial wall thickening in 4 cases.Bronchoalveolar lavage (BAL) was performed in 4 cases, and flocculent secretion was found in the bronchus.Membranous substance was formed in the bronchus in 3 cases, and some lumens were completely occluded and dredged by foreign body forceps.After treatment with Fluticasone, Azithromycin and Montelukast sodium (FAM regimen), the pulmonary function of 5 cases(71.4%) was significantly improved, but ineffective in 2 cases.Conclusions:BOS after HSCT in children mainly begins with dry cough and shortness of breath after activity.Regular screening of pulmonary function is beneficial to identify asymptomatic children.BAL can clear inflammatory cytokines, which is conductive to the following drug treatment.If necessary, foreign forceps should be used to dredge the occluded bronchus to relieve symptoms quickly.FAM regimen is an effective treatment method, and timely adjustment of treatment according to the disease situation can improve the prognosis.
