Airflow obstruction after myeloablative allogeneic hematopoietic stem cell transplantation.
Despite advances in the management of myeloablative allogeneic hematopoietic stem cell transplants, airflow obstruction (AFO) remains a significant complication. We conducted a 12-year study to examine the recent epidemiology of AFO and its associated mortality. Using the rate of percent predicted FEV1 decline after transplant, we defined AFO as a more than 5% per year decline in percent predicted FEV1 with the lowest post-transplant FEV1/FVC ratio less than 0.8. New obstruction was more frequent than previous estimates (26% overall, 32% among patients with chronic graft-versus-host disease [GVHD]) and was significantly associated with older age at transplant, lower pretransplant FEV1/FVC ratio, history of both acute and chronic GVHD, and respiratory viral infection within the first 100 days after transplant. AFO was associated with significant attributable mortality rates of 9% at 3 years, 12% at 5 years, and 18% at 10 years after transplant, which were much higher for the subpopulation of patients with chronic GVHD (22% at 3 years, 27% at 5 years, and 40% at 10 years). These results suggest that the incidence of AFO may have been underestimated previously, and its presence significantly increases the mortality of long-term survivors of myeloablative allogeneic hematopoietic stem cell transplant patients.
Chien
Jason W
JW
Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., D3-190, P.O. Box 19024, Seattle, WA 98109-1024, USA. jchien@fhcrc.org
Martin
Paul J
PJ
Gooley
Ted A
TA
Flowers
Mary E
ME
Heckbert
Susan R
SR
Nichols
W Garrett
WG
Clark
Joan G
JG
D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000401:mortality; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors