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Significance of alveolar nitric oxide concentration in the airway of patients with organizing pneumonia after allogeneic hematopoietic stem cell transplantation

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Abstract

Organizing pneumonia (OP) is a complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and a manifestation of peripheral airway/alveolar inflammation. Recently, alveolar nitric oxide concentration (Calv) has been revealed as a noninvasive marker of peripheral airway inflammation; however, whether Calv levels are associated with OP and peripheral airway in patients after allo-HSCT remains unclear. Herein, we evaluated whether Calv levels could reflect the presence of OP and structural airway changes in patients after allo-HSCT. We measured the eNO levels of 38 patients (6 with OP and 32 without OP) who underwent allo-HSCT. Three-dimensional computed tomography (CT) analysis of the airway was performed in 19 patients. We found that in patients with OP, Calv levels were significantly higher than in those without OP (10.6 vs. 5.5 ppb, p < 0.01). Receiver-operating characteristic analyses revealed a Calv cut-off value for OP detection of 10.2 ppb. No significant differences in the patient characteristics, except for the presence of OP (p < 0.01), were noted between the two groups stratified by the Calv cut-off value. Three-dimensional CT images of the airway revealed gradually increasing positive correlations between Calv levels and airway wall area of the third-, fourth-, and fifth-generation bronchi (r = 0.20, 0.31, 0.38; p = 0.42, 0.19, 0.038, respectively), indicating that Calv levels are strongly correlated with the wall thickness of the distal bronchi. Our results suggest that the Calv level may be a useful noninvasive detectable marker for OP after an allo-HSCT.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank all the participants, physicians, and staff of the Yamaguchi University Hospital and the Yamaguchi-Ube Medical Center who participated in this study. The authors would also like to thank the radiological technologists of the Yamaguchi-Ube Medical Center for their kind assistance.

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Authors and Affiliations

  1. Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan

    Yasuko Kajimura, Yukinori Nakamura, Yoshinori Tanaka, Kaoru Yamamoto, Yoshihiro Tokunaga, Takahiro Sasaki, Toshiaki Yujiri & Yukio Tanizawa

  2. Department of Respiratory Medicine and Infectious Disease, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan

    Tsunahiko Hirano & Kazuto Matsunaga

  3. Department of Medicine and Clinical Science, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan

    Keiji Oishi

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  1. Yasuko Kajimura
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Contributions

Y.K., Y.N., and T.H. designed the study. Y.K. and Y.N. wrote the manuscript. Y.K. analyzed the data. All authors discussed the results and approved the final manuscript.

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Correspondence to Yukinori Nakamura.

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Approval was obtained from the Institutional Review Board of the Yamaguchi University Hospital (approval numbers: H28-175 and H2019-120). The study was conducted in accordance with the principles of the Declaration of Helsinki.

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Written informed consent was obtained from all individuals who participated in the study.

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The authors declare no competing interests.

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Kajimura, Y., Nakamura, Y., Hirano, T. et al. Significance of alveolar nitric oxide concentration in the airway of patients with organizing pneumonia after allogeneic hematopoietic stem cell transplantation. Ann Hematol 101, 1803–1813 (2022). https://doi.org/10.1007/s00277-022-04868-x

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