Chest
Volume 102, Issue 5, November 1992, Pages 1484-1490
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Clinical Investigations
Pretransplant Pulmonary Function Predicts Cytomegalovirus-Associated Interstitial Pneumonia following Bone Marrow Transplantation

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Study Objective

To determine the value of pulmonary function tests (PFTs) in predicting the development of human cytomegalovirus (CMV)-associated interstitial pneumonia (IP) in allogeneic bone marrow transplant (BMT) recipients.

Design

Nonrandomized, prospective, open-trial study.

Setting

Tertiary referral medical center.

Patients

66 evaluable CMV-seropositive patients with hematologic malignancies who were undergoing allogeneic BMT.

Intervention

FEV1, FVC, FEV1/FVC, TLC, Dcoc/VA, PaO2, and P(A-a)O2 were measured on days – 13, +33, and + 44 following BMT. CMV-IP was diagnosed when typical roentgenographic findings developed with confirmatory positive bronchoalveolar lavage (BAL) using standard cytologic and/or rapid culture techniques.

Measurement and Main Results

Univariate logistic regression analysis to predict the development of CMV-IP revealed significant associations with the day – 13 and + 33 percent predicted FEV1, FVC, and TLC (p<0.01) but no associations with other PFT parameters or with changes in these parameters. Stepwise logistic regression analysis demonstrated that only BAL positivity for CMV (odds ratio 14.8; p = 0.0002) and day – 13 percent predicted FEV1 (odds ratio 0.92; p = 0.0004) were significant independent predictors of CMV-IP.

Conclusion

Pretransplant lung function is a previously unrecognized strong predictor and risk factor for the subsequent development of CMV-IP in BMT recipients.

Section snippets

Patients

During the two-year period 1987-1989, patients undergoing allogeneic BMT for hematologic malignant neoplasms at the City of Hope National Medical Center, Duarte, Calif, were entered into a natural history study of CMV-IP The study involved prospective PFTs, BAL on day +35 and +49 with microbiologic assessment, and documentation of clinical course as described below. Patients who were positive for CMV by BAL performed routinely on day + 35 following BMT were also entered into a randomized

RESULTS

A total of 90 patients were enrolled during a 29-month period. Day +35 BAL was positive for CMV by viral culture and/or cytologic criteria in 26 of these patients, 12 of whom were randomized to receive ganciclovir prophylaxis and were therefore excluded from the present PFT study analysis. Another one of the 26 patients was too ill to perform any of the scheduled PFTs. An additional six patients did not have baseline PFT data due to scheduling errors and therefore also had to be excluded. Five

DISCUSSION

The present study demonstrates that reduction in pretransplant FEV1 is a strong predictor for the subsequent development of CMV-IP in seropositive allogeneic BMT recipients. Reduction in FVC and TLC, which tends to parallel decrements in FEV1 in restrictive disorders, also carries predictive value. Interestingly, however, Dcoc, Dcoc/VA and P(A-a)O2, which are generally considered to be more sensitive indices of early interstitial pulmonary dysfunction, were not found to have predictive value.

ACKNOWLEDGMENTS

: The writers wish to thank Rhonda Lusk for manuscript preparation and Kirk McClelland for technical assistance.

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  • Cited by (0)

    This investigation was supported by grant 2R01-CA-30206-08 and by a grant from Syntex Corporation, Palo Alto, Calif.

    Manuscript received September 18, 1991; revision accepted April 6.

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