Am. J. Respir. Crit. Care Med., Vol 152, No. 2, Aug 1995, 690-695.
Abnormalities of pulmonary function tests after marrow transplantation predict nonrelapse mortality
SW Crawford, M Pepe, D Lin, F Benedetti and HJ Deeg
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA.
To determine whether pulmonary function test (PFT) results after marrow
transplantation were predictive of nonrelapse mortality, a review was made
of prospective, nonrandomized PFT results for association with nonrelapse
mortality by log-rank test and Cox proportional hazards modeling. The
setting was a tertiary referral center. The patients were all marrow
recipients who performed PFT between Days 60 and 120 after marrow
transplantation between July 1, 1983 and December 31, 1990 (n = 906). At 3
mo after transplantation, the mean values for total lung capacity (TLC) and
diffusing capacity decreased, and restrictive ventilatory defects (TLC <
80% of predicted) were noted in 34% of the cohort. Airflow rates (FEV1/FVC)
were unchanged. A restrictive lung defect at 3 mo after transplant or a
significant decline (> or = 15%) in TLC from baseline despite remaining
within the normal range was associated with a twofold increased risk of
nonrelapse mortality. Neither airflow obstruction nor impairment in
diffusing capacity was associated with an increased risk. Abnormalities of
the TLC at 3 mo after transplant were associated with death with
respiratory failure, but not with an increased risk of chronic
graft-versus-host disease (GVHD). There is an increase in the nonrelapse
mortality rate associated with either the presence of a restrictive defect
3 mo after marrow transplantation or a significant decline in lung volume
compared with baseline. This effect is most pronounced more than 1 yr after
marrow transplant and appears to be a result of an increase in the rate of
death with respiratory failure, not chronic GVHD.(ABSTRACT TRUNCATED AT 250
WORDS)
