The study, “De novo bronchiectasis in haematological malignancies: patient characteristics, risk factors and survival,” was published in the journal ERJ Open Research.
Previous case reports have suggested that people with blood cancers are more susceptible to develop secondary immunodeficiency and respiratory infections. That in turn would put them at a higher risk of developing bronchiectasis, a chronic lung disease that can have a strong negative impact on the person’s quality of life and life expectancy.
To learn more, investigators from the Centre for Inflammation and Tissue Repair (CITR) at University College London (UCL), in the U.K., carried out a retrospective review to explore the relationship between blood cancers and the onset of bronchiectasis in more depth.
The study included data from 75 patients (median age of 59 years) with different types of blood malignancies and a confirmed diagnosis of bronchiectasis, who had been followed at CITR between January 2014 and April 2018. More than half (54.7%) of the patients included in the study had been followed for a period of five years.
None of these individuals showed signs of bronchiectasis in computed tomography (CT) scans at the time they were diagnosed with cancer. Almost a third (29.3%) were diagnosed with non-Hodgkin’s lymphoma (NHL), and approximately a fourth (22.7%) with chronic lymphocytic leukemia (CLL).
More than half (60%) of the cancer patients had received a hematopoetic stem cell transplant (HSCT) to restore the production of healthy white blood cells and the normal function of their immune system. Among those who did, the majority (82.2%) received the transplant from an unrelated donor, which is called an allograft transplant.
A total 50.7% of those included in the study were immunodeficient, and almost a third — 26.7% — were immunodeficient and had previously received HSCT.
Allograft HSCT and IgG deficiency (immunodeficiency) were seen as two of the most likely causes of bronchiectasis in these patients. In a smaller sub-group of patients, “bronchiectasis was suspected to be related to CLL, intrapulmonary lymphoma, or post-radiotherapy.” The origin of bronchiectasis was unclear in five individuals.
After being diagnosed with cancer, most study participants started showing signs of bronchiectasis after a median time of five years. The onset of bronchiectasis happened sooner among those who received HSCT (median of three years), and also among those who had been treated with the cancer therapy rituximab (median of four years).
Statistical analyses also revealed that those receiving treatment with rituximab were more likely to develop IgG deficiency.
The mortality rates were high, with only 59% of the study participants estimated to be alive 10 years after being diagnosed with bronchiectasis.
“Nonsurvivors had a median survival of 324 days, with the majority of patients post-HSCT dying within 2 years of the bronchiectasis diagnosis (76.9% versus 42.9% of the non-HSCT patients),” the researchers said.
“Overall, our data suggest that patients with haematological malignancy can rapidly develop bronchiectasis, especially those receiving rituximab or allograft HSCT, and this disease may make a significant contribution to their morbidity and perhaps mortality,” they concluded.