title: Risk factors for airflow obstruction in recipients of bone marrow transplants.
abstract: Obstructive lung disease is a complication of bone marrow transplantation. To identify risk factors we analyzed pulmonary function tests of 281 adult patients 1 year after marrow transplantation. The forced expiratory volume at 1 second divided by the forced vital capacity (FEV1/FVC) was used to measure airflow rates. Factors associated with a lower year-1 FEV1/FVC (%) included increased age (p less than 0.0001), male gender (p = 0.02), cigarette smoking (p = 0.01), lower FEV1/FVC before transplantation (p less than 0.0001), HLA-nonidentical grafts (p = 0.001), chronic graft-versus-host disease (p = 0.0002), and immunosuppressive therapy with methotrexate (p = 0.01). There was no significant association between the year-1 FEV1/FVC and underlying disease, dose of conditioning irradiation, or development of acute graft-versus-host disease. Linear multivariate regression analysis, after controlling for the FEV1/FVC before transplantation, shows both chronic graft-versus-host disease and administration of methotrexate independently associated with decrements in the year-1 FEV1/FVC. The combined occurrence of chronic graft-versus-host disease and methotrexate also was strongly associated with decreases in the year-1 FEV1/FVC, indicating an interaction of these risk factors.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: J G
authors.initials: JG
authors.lastname: Clark
authors.forename: D A
authors.initials: DA
authors.lastname: Schwartz
authors.forename: N
authors.initials: N
authors.lastname: Flournoy
authors.forename: K M
authors.initials: KM
authors.lastname: Sullivan
authors.forename: S W
authors.initials: SW
authors.lastname: Crawford
authors.forename: E D
authors.initials: ED
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016026:Bone Marrow Transplantation; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006086:Graft vs Host Disease / Q000503:physiopathology; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000209:etiology*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D014797:Vital Capacity
chemical_list: D008727:Methotrexate