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Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation.
T K Marras1, C K Chan, J H Lipton
1Joint Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. ted.marras@utoronto.ca
Bone Marrow Transplantation
|January 13, 2004
Summary
Pulmonary function testing after allogeneic marrow transplant shows common diffusion impairment, decreasing obstruction, and stable restriction. Obstruction is linked to mortality and chronic graft-versus-host disease, while non-sibling donors increase restriction risk.
Area of Science:
- Pulmonary Medicine
- Hematology
- Transplantation Immunology
Background:
- Allogeneic bone marrow transplantation (BMT) can lead to long-term pulmonary complications.
- Understanding the natural history and risk factors for these complications is crucial for patient management.
Purpose of the Study:
- To evaluate long-term pulmonary function test (PFT) outcomes in survivors of allogeneic BMT.
- To identify factors associated with pulmonary obstruction, restriction, and diffusion impairment.
- To assess the impact of these impairments on mortality.
Main Methods:
- Retrospective cohort study of 6-month survivors of allogeneic BMT (1980-1997).
- Analysis of pulmonary function tests including FEV1/FVC, TLC, and diffusion capacity.
- Statistical analysis to determine prevalence, trends, and associations with mortality and clinical factors.
Main Results:
- Over 5 years, mean declines were observed in FEV1/FVC (4%), TLC (7%), and diffusion (17%), with TLC and diffusion tending to increase later.
- Prevalence of abnormalities: 6% obstruction, 12% restriction, 35% diffusion impairment.
- Obstruction decreased in frequency over time (5% vs 15%) and was associated with higher mortality (HR 2.0).
- Chronic graft-versus-host disease (cGVHD) and busulfan were linked to obstruction; non-sibling/mismatched donors were linked to restriction.
Conclusions:
- Decreased diffusion capacity is common but generally benign after BMT.
- Pulmonary obstruction, while decreasing in frequency, is associated with increased mortality and cGVHD.
- Risk factors for restriction include using non-sibling or mismatched donors.