title: Telemetric monitoring of pulmonary function after allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Late-onset noninfectious pulmonary complications (LONIPC) are both frequent and severe after allogeneic hematopoietic stem cell transplantation (HSCT). The high mortality rate (40-80%) may be related to delayed diagnosis. We assessed the use of telemetric home surveillance of pulmonary function for early diagnosis of LONIPC in transplant recipients.
  
  
  METHODS
  This prospective study monitored pulmonary function in 37 allogeneic HSCT recipients. About 3 months after HSCT, they received a portable spirometer that measured forced vital capacity, forced expiratory volume per second, and midexpiratory flow 25-75 (MEF25-75). Data were transmitted twice weekly by telephone. Conventional plethysmography confirmed any significant deterioration (>20%).
  
  
  RESULTS
  Thirteen episodes of spirometric deterioration were detected by telemetry in 11 patients during a median 17-month (4-41) follow-up period after transplantation. In these cases, examinations including spirometry, high-resolution thoracic computed tomography and bronchoalveolar lavage diagnosed LONIPC in eight episodes in seven patients (cumulative incidence 23.4%, SE 0.08, at month 24 after transplant): bronchiolitis obliterans (BO, n=3), interstitial pneumonia (IP, n=4), or both BO and IP (n=1). Five episodes improved and three were stabilized with increased immunosuppressive therapy. At the last follow-up, of the seven patients with LONIPC, one successfully stopped immunosuppressive therapy, two were receiving low-dose mycophenolate mofetil, and four were receiving low-dose corticosteroid therapy. There were no cases of respiratory failure and no patient died from LONIPC.
  
  
  CONCLUSIONS
  Telemetric home monitoring of pulmonary function is a useful procedure for early diagnosis of LONIPC before clinical pulmonary symptoms and may improve outcome after allogeneic HSCT.
authors.affiliation: Service de Pneumologie, Hôpital Foch, Suresnes, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Guihot
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Becquemin
authors.forename: Louis-Jean
authors.initials: LJ
authors.lastname: Couderc
authors.forename: Odile
authors.initials: O
authors.lastname: Randrianarivelo
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Rivaud
authors.forename: Bruno
authors.initials: B
authors.lastname: Philippe
authors.forename: Laurent
authors.initials: L
authors.lastname: Sutton
authors.forename: Hélène
authors.initials: H
authors.lastname: Neveu
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Tanguy
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Vernant
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dhédin
mesh_terms: D000328:Adult; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007938:Leukemia / Q000188:drug therapy / Q000628:therapy; D008171:Lung Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D018655:Lymphocyte Count; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy; D010297:Paris; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012129:Respiratory Function Tests; D013147:Spirometry; D013686:Telemetry; D014184:Transplantation, Homologous / Q000502:physiology*