Doğanay ALPER, Mutlu ARAT, Özdemir Özlem KUMBASAR, Haluk KOÇ

Kemik iliği transplantasyonuna bağlı bronşiyolitis obliterans

Kemik iliği transplantasyonu (KİT) sonrası bronşiyolitis obliterans (BO) tanısı alan 12 hasta retrospektif olarak değerlendirildi. Olguların 8'i kadın, 4'ü erkekti; transplantasyon sırasındaki median yaş 32.5 idi. En sık görülen semptomlar efor dispnesi ve kuru öksürüktü; KİT uygulaması ile semptomların başlangıcı arasındaki median süre 6 aydı. Tüm olguların kronik graft versus host hastalığı vardı. Solunum fonksiyon testlerinde obstrüktif defektle birlikte difüzyon defekti saptandı. Hastaların toraks yüksek rezolüsyonlu bilgisayarlı tomografilerinde bronşiyal dilatasyon izlendi; 9 olguda ayrıca hava hapsi saptandı. Olgulardan 10'una aldıkları immünsüpresif tedaviye ek olarak sistemik steroid, inhaler steroid ve bronkodilatör verildi; 2 olguya sadece inhaler steroid ve bronkodilatör eklendi. Bu tedavi ile parsiyel yanıt alındı. Üç olgu solunum yetmezliği ile kaybedildi. BO önemli bir morbidite ve mortalite nedenidir; tedavisi güçtür. Solunum sistemi semptomları olan olgular fonksiyonel olarak değerlendirilmelidir. BO tedavisinde özellikle inhaler steroidlerin etkisini araştırmak için kontrollü çalışmaların yapılması yararlı olacaktır.

Bronchiolitis obliterans due to bone marrow transplantatiıon

Twelve patients diagnosed as having bronchiolitis obliterans (BO) after bone marrow transplantation (BMT) were evaluated retrospectively. Eight of patients were female, four of them were male; median age at transplantation was 32.5. Most common symptoms were exertional dyspnea and nonproductive cough; median time between BMT and the onset of symptoms was 6 months. All cases had chronic graft versus host disease. Pulmonary function tests showed obstructive defect and diffusion defect. Thoracic high resolution computed tomography scans revealed bronchial dilatation; in nine patients air trapping was also detected. Ten patients were given steroid, inhaled steroid and bronchodilator therapy in addition to immunsupressive treatment that was prescribed previously; in two patients only inhaled steroid and bronchodilator were added. Partial response was achieved with this treatment. Three patients died because of respiratory failure. BO is an important cause of morbidity and mortality; its treatment is difficult. Patients with respiratory symptoms should be evaluated functionally. Controlled studies particularly investigating the effects of inhaled steroids on BO will be useful.

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