Lung function and long-term complications after allogeneic hematopoietic cell transplant.
It is unknown if diminished pulmonary function early after allogeneic hematopoietic transplant is associated with poor long-term outcomes. The objective of this study was to determine if posttransplant lung function is associated with 5-year nonrelapse mortality (NRM) and the development of chronic graft-versus-host disease (cGVHD). Retrospective analysis was done for 2158 patients who had routine pulmonary function testing 60-120 days after transplant between 1992 and 2004. Cox regression was used to assess the hazard ratio for 5-year NRM. A second analysis assessed the hazard ratio for the development of cGVHD. Lung function score was the primary exposure, and was calculated according to forced expiratory volume in 1 second (FEV(1)) and carbon monoxide diffusion capapcity (DLCO). Individual pulmonary function parameters were secondary exposures. The primary outcomes were 5-year NRM and the development of cGVHD. Most patients had normal lung function following transplant. A higher lung function score, signifying greater impairment, was associated with an increased risk of mortality (category 1 hazard ratio [HR] 1.47 [1.17-1.85]; category 2 HR 3.38 [2.53-4.53]; category 3 HR 7.80 [4.15-14.68]). A similar association was observed for all individual pulmonary function parameters. Low FEV(1) was associated with the subsequent development of cGVHD (FEV(1) 70%-79% HR 1.26 [1.01-1.57]; 60%-69% HR 1.48 [1.10-2.01]; <60% HR 2.02 [1.34-3.05]). Models using either lung function score or individual pulmonary function parameters performed about equally well as judged by the C-statistic. Impaired lung function at day 80 posttransplant was associated with a higher risk of NRM. A low FEV(1) following transplant was associated with developing cGVHD within 1 year.
Walter
Eric C
EC
Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington, USA. ericw@u.washington.edu
Orozco-Levi
Mauricio
M
Ramirez-Sarmiento
Alba
A
Vigorito
Afonso
A
Campregher
Paulo V
PV
Martin
Paul J
PJ
Flowers
Mary E
ME
Chien
Jason W
JW
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005541:Forced Expiratory Volume; D006086:Graft vs Host Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000145:classification / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult