Chest
Predictive Value of Pulmonary Function Tests before Marrow Transplantation
Section snippets
Subjects and PFT Methods
All marrow recipients who performed PFT before a first marrow transplantation for malignant neoplasms between January 1986 and July 1990 were included in the study (n = 1,297). This represented 87 percent of marrow transplants performed at the center during this interval. Testing was done using American Thoracic Society guidelines.8 A pulmonary function analyzer (Gould 1000 IV, Gould, Inc, Dayton, Ohio) was used with nitrogen washout to determine lung volumes. The diffusing capacity for carbon
Patient Characteristics
Between January 1986 and July 1990, 1,297 marrow recipients with malignant neoplasms performed PFT within two weeks before transplantation (Table 1). The patients ranged in age from 4 to 63 years (mean and median = 31 years). Most (82 percent) received allogeneic transplants. Eight-one percent of the donor marrows were phenotypically HLA identical with the recipient. Almost half (48 percent) of all patients had active malignant disease (morphologic or cytogenetic relapse of leukemia or
DISCUSSION
This analysis of 1,297 marrow transplant recipients for treatment of malignant disease demonstrates predictive value of PFT abnormalities for death after transplant. The study was limited to patients who had undergone transplants for malignant neoplasms because of the lower complication and mortality rates among patients who had undergone transplants for aplastic anemia. The strengths of the analysis lie, in part, in the large numbers of assessable patients, the prospective collection of all
REFERENCES (25)
- et al.
Pulmonary complications of bone marrow transplantation
Chest
(1985) - et al.
Longitudinal changes in pulmonary function following bone marrow transplantation
Chest
(1989) - et al.
Techniques for human marrow grafting
Blood
(1970) - et al.
Cyclosporine as prophylaxis for graft-versus-host disease: a randomized study on patients undergoing marrow transplantation for nonlymphoblastic leukemia
Blood
(1985) - et al.
Marrow transplantation for chronic myelocytic leukemia: a controlled trial of cyclosporine versus methotrexate for prophylaxis of graft-versus-host disease
Blood
(1985) - et al.
Risk factors for airflow obstruction in recipients of bone marrow transplants
Ann Intern Med
(1987) - et al.
Small-airways disease in recipients of allogeneic bone marrow transplants
Medicine
(1987) - et al.
Pulmonary function of marrow transplant patients, I: effects of marrow infusion, acute graft-versus-host-disease, and interstitial pneumonitis
Exp Hematol
(1984) - et al.
Lung function changes after allogeneic bone marrow transplantation
Thorax
(1986) - et al.
Pulmonary function changes in long-term survivors of allogeneic marrow transplantation
ATS statement-Snowbird workshop in standardization of spirometry
Am J Respir Dis
Respiratory function tests: normal values at median altitudes and the prediction of normal results
Am Rev Tuberculosis
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Adjusting diffusing capacity for anemia in patients undergoing allogeneic HCT: a comparison of two methodologies
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2023, Transplantation and Cellular TherapyMiscellaneous Complications of Hematopoietic Cellular Transplantation
2023, Manual of Hematopoietic Cell Transplantation and Cellular TherapiesImpact of Lung Function on Bronchiolitis Obliterans Syndrome and Outcome after Allogeneic Hematopoietic Cell Transplantation with Reduced-Intensity Conditioning
2018, Biology of Blood and Marrow TransplantationCitation Excerpt :Of note, patients with small airway disease defined as FEF25-75 <60% of predicted before allo-HCT had also higher risk of death (HR, 1.57; 95% CI, 1.13 to 2.19; P = .007) due mainly to NRM (subhazard ratio, 1.97; 95% CI, 1.72 to 3.31; P = .01) (Supplementary Table 9). In addition, CO-diffusion abnormalities before allo-HCT has previously been shown to be associated with increased mortality, although the threshold of DLCOcSB increasing NRM varies among studies probably due to patient characteristics, conditioning regimen, and GVHD prophylaxis [13,46,47]. Previous studies have associated the decrease of DLCOcSB and FEV1 with NRM due to pulmonary toxicity, GVHD, and infections [13].
Pulmonary Function and Pretransplant Evaluation of the Hematopoietic Cell Transplant Candidate
2017, Clinics in Chest MedicineCitation Excerpt :Studies from the 1980s and 1990s showed that a reduced FEV1 was associated with early complications; however, the association with mortality remained controversial, perhaps owing to the relatively small numbers of patients and fatal respiratory events.17–19 Notably, Crawford and Fisher19 analyzed 1297 predominantly allogeneic HCT recipients (82%) during an early era of transplantation (1986–1990) and showed that gas exchange abnormalities, and not spirometric parameters or lung volumes, were associated with increased mortality. In a larger, more contemporary cohort of 2852 allogeneic HCT recipients from the same center, Parimon and colleagues20 showed that progressively more abnormal pretransplant FEV1 was associated independently with stepwise increased risk of early respiratory failure, with an HR of 2.7 to 2.9 (95% confidence interval [CI], 1.7–4.2), and that a pretransplant FEV1 of less than 70% predicted was associated with a 1.7- to 2.2-fold increase in mortality.
This investigation was supported by Public Health Service grants CA-18029 and CA-47748 from the National Cancer Institute and grant HL-36444 from the National Heart, Lung, Blood Institute.