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Airflow Obstruction after Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation

Division of Clinical Research, Fred Hutchinson Cancer Research Center; and Department of Epidemiology, University of Washington, Seattle, Washington

Correspondence and requests for reprints should be addressed to Dr. Jason W. Chien, M.D., Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., D3–190, P.O. Box 19024, Seattle, WA 98109–1024. E-mail: jchien{at}fhcrc.org

Despite advances in the management of myeloablative allogeneic hematopoietic stem cell transplants, airflow obstruction (AFO) remains a significant complication. We conducted a 12-year study to examine the recent epidemiology of AFO and its associated mortality. Using the rate of percent predicted FEV₁ decline after transplant, we defined AFO as a more than 5% per year decline in percent predicted FEV₁ with the lowest post-transplant FEV₁/FVC ratio less than 0.8. New obstruction was more frequent than previous estimates (26% overall, 32% among patients with chronic graft-versus-host disease [GVHD]) and was significantly associated with older age at transplant, lower pretransplant FEV₁/FVC ratio, history of both acute and chronic GVHD, and respiratory viral infection within the first 100 days after transplant. AFO was associated with significant attributable mortality rates of 9% at 3 years, 12% at 5 years, and 18% at 10 years after transplant, which were much higher for the subpopulation of patients with chronic GVHD (22% at 3 years, 27% at 5 years, and 40% at 10 years). These results suggest that the incidence of AFO may have been underestimated previously, and its presence significantly increases the mortality of long-term survivors of myeloablative allogeneic hematopoietic stem cell transplant patients.

Key Words: bronchiolitis obliterans • hematopoietic stem cell transplant • airflow obstruction

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