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Published on: October 31, 2012
Hb-adjusted DLCO with GLI reference predicts long-term survival after HSCT in children
Hye Jin Lee1, Kyunghoon Kim1, Seong Koo Kim1
1Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Insights
Pretransplant diffusing capacity, specifically adjusted carbon monoxide diffusing capacity (DLCOadj), predicts non-relapse mortality (NRM) after pediatric allogeneic hematopoietic stem cell transplantation (allo-HSCT). Worse DLCOadj indicates a higher risk of NRM in children undergoing allo-HSCT.
Area of Science:
- Pediatric Hematology/Oncology
- Pulmonary Medicine
- Transplantation Medicine
Background:
- Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative option for pediatric malignancies.
- Pulmonary complications, including non-relapse mortality (NRM), remain a significant concern post-transplant.
- Pretransplant pulmonary function assessment is crucial for risk stratification.
Purpose of the Study:
- To evaluate the predictive value of pretransplant diffusing capacity for outcomes in pediatric allo-HSCT.
- To determine if diffusing capacity parameters can identify children at higher risk of NRM.
Main Methods:
- Retrospective cohort study of 176 children undergoing allo-HSCT.
- Analysis of pretransplant pulmonary function tests (PFTs), including spirometry, body plethysmography, and diffusing capacity (DLCOadj) using GLI-2017 criteria.
- Kaplan-Meier and multivariate analyses to assess associations with overall survival (OS), disease-related mortality (DRM), and NRM.
Main Results:
- Univariate analysis revealed that grades 3-4 DLCOadj and LFS categories III-IV significantly increased NRM (p=0.003 and p=0.008).
- Multivariate analysis showed grades 3-4 DLCOadj significantly increased NRM risk (HR=4.90, p=0.020).
- Kaplan-Meier analyses demonstrated a significant stepwise increase in NRM with worse pretransplant DLCOadj grades and LFS categories (p<0.001 and p=0.003).
Conclusions:
- Compromised pretransplant diffusing capacity and high LFS are significant predictors of NRM after pediatric allo-HSCT.
- DLCOadj is a valuable predictor of NRM in pediatric patients with malignancy undergoing allo-HSCT.
- Pretransplant DLCOadj assessment can aid in risk stratification and management strategies.
Abstract:
This study aimed to evaluate the pretransplant diffusing capacity as a predictor of outcomes in pediatric allogeneic hematopoietic stem cell transplantation (allo-HSCT). Retrospective cohort study of 176 children followed outcomes for 5 years after allo-HSCT. We conducted an analysis of PFTs include spirometry, body plethysmography, and diffusing capacity prior to allo-HSCT. We analyzed the probabilities of overall survival (OS), disease-related mortality (DRM), and non-relapse mortality (NRM). Of all carbon monoxide diffusing capacity (DLCO) parameters obtained using the Global Lung Function Initiative (GLI)-2017, univariate analysis showed that the grade 3, 4 of DLCOadj and Category III, IV of LFS significantly increase NRM (p = 0.003 and p = 0.008). Multivariate analysis indicated that a significant increase in the risk of NRM is associated with grades 3, 4 DLCOadj (hazard ratio [HR] = 4.90, p = 0.020). Kaplan-Meier analyses showed that a significant stepwise increase in NRM was observed with both worse pretransplant DLCOadj grades and LFS categories (p < 0.001 and p = 0.003). A compromised pretransplant diffusing capacity and a high LFS significantly increase the risk of NRM. Especially, DLCOadj before transplantation can be used as an important predictor of NRM after allo-HSCT in children with malignancy.
