title: Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation.
abstract: We studied long-term pulmonary function testing (PFT) in a retrospective cohort of 6-month survivors of allogeneic marrow transplant (BMT) between 1980 and 1997. Of 593 patients, 73, 71 and 65% had adequate data to assess for obstruction, restriction and diffusion impairments respectively. Over 5 years, mean declines in 1-s forced expiratory volume/forced vital capacity (FEV1/FVC), total lung capacity (TLC) and diffusion were 4, 7 and 17%, respectively. TLC and diffusion tended to subsequently increase. In all, 6, 12 and 35% of patients met criteria for obstruction, restriction and impaired diffusion, respectively. Obstruction was less common in recent transplants (5 vs 15%, P=0.004), while restriction and diffusion impairment rates remained stable. There was significantly greater mortality with obstruction (HR 2.0 (1.04-3.95)), and a nonstatistically significant higher mortality rate with restriction (HR 1.6 (0.95-2.75)), but not with impaired diffusion (HR=0.99 (0.65-1.50)). cGVHD (OR 16.7 (2.2-129.8)) and busulfan (OR 2.9 (1.01-8.24)) were associated with obstruction. Marrow from nonsibling or mismatched donors (OR 4.9 (2.2-10.7)) was associated with restriction. In summary, after BMT, decreased diffusion capacity is common and benign; obstruction has decreased in frequency, is rare without cGVHD, and is associated with mortality; nonsibling and mismatched donor are risk factors for restriction.
authors.affiliation: Joint Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. ted.marras@utoronto.ca
authors.forename: T K
authors.initials: TK
authors.lastname: Marras
authors.forename: C K
authors.initials: CK
authors.lastname: Chan
authors.forename: J H
authors.initials: JH
authors.lastname: Lipton
authors.forename: H A
authors.initials: HA
authors.lastname: Messner
authors.forename: J P
authors.initials: JP
authors.lastname: Szalai
authors.forename: A
authors.initials: A
authors.lastname: Laupacis
mesh_terms: D000208:Acute Disease; D000328:Adult; D016026:Bone Marrow Transplantation / Q000401:mortality*; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000150:complications* / Q000401:mortality*; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D008297:Male; D011237:Predictive Value of Tests; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous