Restrictive Ventilatory Defects Following Hematopoietic Stem Cell Transplant Are Associated With Increased Mortality

Area of Science:

• Hematology
• Pulmonology
• Oncology

Background:

• Hematopoietic cell transplantation (HCT) offers a potential cure for hematologic malignancies but is complicated by post-transplant issues.
• Pulmonary complications, specifically restrictive ventilatory defect (RVD), are a significant challenge, yet their epidemiology post-HCT remains understudied.

Purpose of the Study:

• To investigate the incidence, causes, and impact of new-onset RVD following HCT on overall survival (OS) and non-relapse mortality (NRM).

Main Methods:

• Retrospective review of adult patients undergoing their first allogeneic HCT for hematologic malignancies.
• Definition of RVD: total lung capacity (TLC) <5th percentile of the lower limit of normal.
• Analysis using Kaplan-Meier, log-rank tests, and Cox regression models.

Main Results:

• Among 3030 patients, 270 developed new-onset RVD post-HCT.
• Common causes included respiratory infections (23%), interstitial lung disease (15%), and truncal sclerosis (11%).
• Multivariate analysis identified increased age, unrelated donor, mismatched related donor, cord blood source, pre-existing RVD, and chronic GVHD as risk factors for mortality. More severe RVD, progressive RVD, and early onset (<1 year) significantly increased mortality.

Conclusions:

• New-onset RVD following HCT is a significant independent predictor of increased mortality.
• Proactive pulmonary function monitoring is essential for early identification of RVD and improving post-HCT outcomes.