Pretransplant pulmonary function predicts cytomegalovirus-associated interstitial pneumonia following bone marrow transplantation.
OBJECTIVE
To determine the value of pulmonary function tests (PFTs) in predicting the development of human cytomegalovirus (CMV)-associated interstitial pneumonia (IP) in allogeneic bone marrow transplant (BMT) recipients.


METHODS
Nonrandomized, prospective, open-trial study.


METHODS
Tertiary referral medical center.


METHODS
66 evaluable CMV-seropositive patients with hematologic malignancies who were undergoing allogeneic BMT.


METHODS
FEV1, FVC, FEV1/FVC, TLC, Dcoc/VA, PaO2, and P(A-a)O2 were measured on days -13, +33, and +44 following BMT. CMV-IP was diagnosed when typical roentgenographic findings developed with confirmatory positive bronchoalveolar lavage (BAL) using standard cytologic and/or rapid culture techniques.


RESULTS
Univariate logistic regression analysis to predict the development of CMV-IP revealed significant associations with the day -13 and +33 percent predicted FEV1, FVC, and TLC (p < 0.01) but no associations with other PFT parameters or with changes in these parameters. Stepwise logistic regression analysis demonstrated that only BAL positivity for CMV (odds ratio 14.8; p = 0.0002) and day -13 percent predicted FEV1 (odds ratio 0.92; p = 0.0004) were significant independent predictors of CMV-IP.


CONCLUSIONS
Pretransplant lung function is a previously unrecognized strong predictor and risk factor for the subsequent development of CMV-IP in BMT recipients.
Horak
D A
DA
Department of Respiratory Diseases, City of Hope National Medical Center, Duarte, CA 91010.
Schmidt
G M
GM
Zaia
J A
JA
Niland
J C
JC
Ahn
C
C
Forman
S J
SJ
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002648:Child; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000175:diagnosis* / Q000209:etiology; D012129:Respiratory Function Tests; D012307:Risk Factors; D014109:Total Lung Capacity; D014797:Vital Capacity