CT Strain Metrics Allow for Earlier Diagnosis of Bronchiolitis Obliterans Syndrome After Hematopoietic Cell Transplant

Authors

Husham Sharifi
Christopher D Bertini
Mansour Alkhunaizi
Maria Hernandez
Zayan Musa
Carlos Borges
Ihsan Turk
Lara Bashoura
Burton F Dickey
Guang-Shing Cheng
Gregory Yanik
Craig J Galban
Huawei Henry Guo
Myrna C B Godoy
Joseph M Reinhardt
Eric A Hoffman
Mario Castro
Gabriela Rondon
Amin M Alousi
Richard E Champlin
Elizabeth J Shpall
Ying Lu
Samuel Peterson
Keshav Datta
Mark R Nicolls
Joe Hsu
Ajay Sheshadri

Publication Date

10-8-2024

Journal

Blood Advances

Abstract

Bronchiolitis obliterans syndrome (BOS) after hematopoietic cell transplantation (HCT) is associated with substantial morbidity and mortality. Quantitative computed tomography (qCT) can help diagnose advanced BOS meeting National Institutes of Health (NIH) criteria (NIH-BOS) but has not been used to diagnose early, often asymptomatic BOS (early BOS), limiting the potential for early intervention and improved outcomes. Using pulmonary function tests (PFTs) to define NIH-BOS, early BOS, and mixed BOS (NIH-BOS with restrictive lung disease) in patients from 2 large cancer centers, we applied qCT to identify early BOS and distinguish between types of BOS. Patients with transient impairment or healthy lungs were included for comparison. PFTs were done at month 0, 6, and 12. Analysis was performed with association statistics, principal component analysis, conditional inference trees (CITs), and machine learning (ML) classifier models. Our cohort included 84 allogeneic HCT recipients, 66 with BOS (NIH-defined, early, or mixed) and 18 without BOS. All qCT metrics had moderate correlation with forced expiratory volume in 1 second, and each qCT metric differentiated BOS from those without BOS (non-BOS; P < .0001). CITs distinguished 94% of participants with BOS vs non-BOS, 85% of early BOS vs non-BOS, 92% of early BOS vs NIH-BOS. ML models diagnosed BOS with area under the curve (AUC) of 0.84 (95% confidence interval [CI], 0.74-0.94) and early BOS with AUC of 0.84 (95% CI, 0.69-0.97). qCT metrics can identify individuals with early BOS, paving the way for closer monitoring and earlier treatment in this vulnerable population.

Keywords

Bronchiolitis Obliterans, Humans, Hematopoietic Stem Cell Transplantation, Male, Female, Middle Aged, Tomography, X-Ray Computed, Adult, Respiratory Function Tests, Early Diagnosis, Aged, Bronchiolitis Obliterans Syndrome

DOI

10.1182/bloodadvances.2024013748

PMID

39163616

PMCID

PMC11470239

PubMedCentral® Posted Date

8-22-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes