Allogeneic HSCT |
Chronic GVHD# |
Insidious onset of dyspnoea, cough and wheezing after 100 days following transplantation |
Normal chest radiograph |
HRCT of the chest (with inspiratory and expiratory views) showing areas of air trapping on expiratory views, hyperinflation or bronchial dilatation, with no parenchymal involvement |
PFT showing new onset of airflow obstruction (FEV1/FVC <0.7 and FEV1 <75% of predicted), not responsive to bronchodilators |
Exclusion of an infectious process by appropriate radiological, serological and microbiological studies (obtained by sinus aspirate, upper respiratory tract viral screen, sputum culture or BAL) |
GVHD: graft versus host disease; HRCT: high-resolution computed tomography; PFT: pulmonary function test; FEV1: forced expiratory volume in one second; FVC: forced vital capacity; BAL: bronchoalveolar lavage. #: The risk of BO is highest with progressive chronic GVHD, but it may develop in patients with quiescent or de novo GVHD, or without chronic GVHD.