Chronic GVHD and pretransplantation abnormalities in pulmonary function are the main determinants predicting worsening pulmonary function in long-term survivors after stem cell transplantation.
Pulmonary function (PF) was studied in 69 consecutive patients with hematologic diseases, with a minimum 5-year (range, 5-13 years) follow-up after allogeneic stem cell transplantation from an HLA-matched sibling. Fifty-six patients (81%) received total body irradiation based myeloablative stem cell transplantation (MT) and 13 (19%) underwent nonmyeloablative stem cell transplantation (NST). Thirty-one patients (45%) developed a late decrease in PF from baseline, 25 with a restrictive and 6 with an obstructive pattern PF abnormality. Twelve patients (17%) were symptomatic, 8 with a severe restrictive PF defect, but none required supplemental oxygen. The incidence of developing a late PF abnormality was comparable in MT (24 of 56) and NST (5 of 13; P = .51). In multivariate analysis, chronic graft-versus-host disease (relative risk, 16) and pretransplantation diffusion capacity for carbon monoxide or forced expiratory volume in the first second <80% predicted were independently associated with a late decrease in PF from baseline (relative risk, 7). Our results indicate that late PF abnormality is common after MT and NST. Patients with a low pretransplantation diffusion capacity for carbon monoxide of or forced expiratory volume in the first second who developed chronic graft-versus-host disease were most severely affected. Longer follow-up is needed to determine whether PF will continue to decrease or reach a plateau and whether more patients with PF abnormality will eventually become symptomatic.
Savani
Bipin N
BN
Hematology Branch, National Heart, Lung and Blood, National Institutes of Health, Bethesda, Maryland 20892-1202, USA.
Montero
Aldemar
A
Srinivasan
Ramaprasad
R
Singh
Anurag
A
Shenoy
Aarthi
A
Mielke
Stephan
S
Rezvani
Katayoun
K
Karimpour
Shervin
S
Childs
Richard
R
Barrett
A John
AJ
D000293:Adolescent; D000328:Adult; D002248:Carbon Monoxide / Q000493:pharmacokinetics; D002648:Child; D002908:Chronic Disease; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006086:Graft vs Host Disease / Q000150:complications*; D006402:Hematologic Diseases / Q000503:physiopathology / Q000601:surgery; D019337:Hematologic Neoplasms / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology*; D016016:Proportional Hazards Models; D011653:Pulmonary Diffusing Capacity; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000009:adverse effects
D002248:Carbon Monoxide