Risk factors for airflow obstruction in recipients of bone marrow transplants.
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.
Clark
J G
JG
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Schwartz
D A
DA
Flournoy
N
N
Sullivan
K M
KM
Crawford
S W
SW
Thomas
E D
ED
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
D008727:Methotrexate