Managing pulmonary cGvHD post-HSCT: A stepwise approach

Pulmonary complications significantly influence outcomes in patients undergoing hematopoietic stem cell transplantation (HSCT). Baker and Baker published a stepwise approach for diagnosing and managing bronchiolitis obliterans syndrome (BOS) and other noninfectious pulmonary complications in patients with chronic graft-versus-host disease (cGvHD) post-HSCT in the Clinical Journal of Oncology Nursing.

Key data: BOS affects ~20% of patients with cGvHD. Most patients are asymptomatic in the early stages, making routine screening through pulmonary function tests (PFTs) and high-resolution computed tomography (CT) essential. A stepwise treatment approach is recommended, involving first-line corticosteroids and adjunct therapy with fluticasone, azithromycin, and montelukast (FAM); second-line therapy for refractory cases; and supportive care to minimize infectious complications. Accurate differentiation from other pulmonary conditions, such as interstitial pneumonia, is critical for improving patient outcomes.

Key learning: A stepwise approach prioritizing early detection and intervention offers a structured framework for optimizing outcomes in patients with cGvHD developing BOS and other noninfectious pulmonary complications.