Abnormalities of pulmonary function tests after marrow transplantation predict nonrelapse mortality.
To determine whether pulmonary function test (PFT) results after marrow transplantation were predictive of nonrelapse mortality, a review was made of prospective, nonrandomized PFT results for association with nonrelapse mortality by log-rank test and Cox proportional hazards modeling. The setting was a tertiary referral center. The patients were all marrow recipients who performed PFT between Days 60 and 120 after marrow transplantation between July 1, 1983 and December 31, 1990 (n = 906). At 3 mo after transplantation, the mean values for total lung capacity (TLC) and diffusing capacity decreased, and restrictive ventilatory defects (TLC < 80% of predicted) were noted in 34% of the cohort. Airflow rates (FEV1/FVC) were unchanged. A restrictive lung defect at 3 mo after transplant or a significant decline (> or = 15%) in TLC from baseline despite remaining within the normal range was associated with a twofold increased risk of nonrelapse mortality. Neither airflow obstruction nor impairment in diffusing capacity was associated with an increased risk. Abnormalities of the TLC at 3 mo after transplant were associated with death with respiratory failure, but not with an increased risk of chronic graft-versus-host disease (GVHD). There is an increase in the nonrelapse mortality rate associated with either the presence of a restrictive defect 3 mo after marrow transplantation or a significant decline in lung volume compared with baseline. This effect is most pronounced more than 1 yr after marrow transplant and appears to be a result of an increase in the rate of death with respiratory failure, not chronic GVHD.(ABSTRACT TRUNCATED AT 250 WORDS)
Crawford
S W
SW
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA.
Pepe
M
M
Lin
D
D
Benedetti
F
F
Deeg
H J
HJ
D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000453:epidemiology; D016026:Bone Marrow Transplantation / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D005544:Forecasting; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011653:Pulmonary Diffusing Capacity; D012123:Pulmonary Ventilation; D012129:Respiratory Function Tests / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000401:mortality; D014109:Total Lung Capacity; D014797:Vital Capacity; D014861:Washington / Q000453:epidemiology