Hematologic Malignancy and Its Treatment Linked to Development of Bronchiectasis

Hematologic Malignancy and Its Treatment Linked to Development of Bronchiectasis

Bronchiectasis was found in patients with hematologic malignancies, independent of subtype; those who have had a stem cell transplant (SCT); developed graft-vs-host disease (GVHD); or those with immunoglobulin deficiency, researchers report.

The study, “De Novo Development of Bronchiectasis in Patients With Hematologic Malignancy,” was published in the journal Chest.

As bronchiectasis can complicate treatments for hematologic malignancies, researchers at the University of Chicago reviewed patients in a bronchiectasis registry and assessed the primary outcome of sputum culture, pulmonary function, and high-resolution CT (HRCT) scans.

Sputum culture indicates the presence of respiratory infection causing bacteria, while HRCT allows the visualization of bronchial tubes. Pulmonary function was assessed using FEV1 (forced expiratory volume) and FVC (forced vital capacity) of the lungs.

Patients were scored between 0-3, with 0 indicating no disease and 3 indicating severe disease, based on their HRCT scan results, bronchial dilatation severity, and bronchial wall thickening.

In total, 22 patients who had both hematologic malignancies and bronchiectasis were analyzed in the study. The median time between the diagnosis of hematologic malignancy and bronchiectasis was 34 months. Almost all patients underwent chemotherapy, 73% had stem cell transplant (SCT) procedures, 64% developed chronic GVHD, and 58% had immunoglobulin deficiencies.

Results showed that nine patients were hospitalized at least once for the treatment of a respiratory infection before receiving an official clinical diagnosis of bronchiectasis. And 14 patients had positive sputum culture results, with the most common bacteria being Pseudomonas aeruginosa.

Lung function analysis indicated that from time of initial hematologic malignancy diagnosis to a bronchiectasis diagnosis, mean FEV1 values significantly decreased. Also, HRCT scans showed that over time, there was a significant decline in bronchial dilation and an increase in airway thickening.

This study was the first to report a significant correlation between the development of bronchiectasis and a prior diagnosis of hematologic malignancy. None of the patients analyzed in the study had a prior diagnosis of, or history of, bronchiectasis.

Many patients in the study had some evidence of GVHD, which may play a role in the development of bronchiolitis obliterans syndrome, which is a chronic lung disease that’s caused by transplants and can lead to bronchiectasis. But not all patients received a transplant, so bronchiolitis obliterans syndrome cannot alone explain the development of bronchiectasis.

Similarly, immunoglobulin deficiency was not present in every patient, and chemotherapy was not administered to every patient, indicating that bronchiectasis was not a result of these factors.

“Our findings support the association of hematologic malignancy and its treatment in the development of bronchiectasis and suggest that neither the presence of hematopoietic SCT or GVHD are prerequisites for bronchiectasis,” the researchers wrote. “Identification of this under-recognized pulmonary complication is important in optimizing care for these patients.”

As for the cause of bronchiectasis, the team speculated that “the development of bronchiectasis could be due to a combination of the previously described risk factors and an unrecognized mechanism directly related to the malignancy itself.”