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Pretransplant Lung Function, Respiratory Failure, and Mortality after Stem Cell Transplantation

Clinical Research Division, Fred Hutchinson Cancer Research Center; and Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington

Correspondence and requests for reprints should be addressed to Jason W. Chien, M.D., Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Suite D5-280, Seattle, WA 98109-1024. E-mail: jchien{at}fhcrc.org

Rationale: The role of pulmonary function before stem cell transplant as a potential risk factor for the development of early post-transplant respiratory failure and mortality is controversial. Methods: We conducted a retrospective analysis of the pretransplant pulmonary function of 2,852 patients who received their transplant between 1990 and 2001. Measurements: Pretransplant FEV₁, FVC, total lung capacity (TLC), diffusing capacity of carbon monoxide (DL_CO), and the alveolar–arterial oxygen tension difference P(A-a)O₂ were measured and assessed for association with development of early respiratory failure and mortality in Cox proportional hazard logistic models. Main Results: In multivariate analyses, progressive decrease of all lung function parameters was associated with a stepwise increase in risk of developing early respiratory failure and mortality when assessed in independent models. On the basis of a significant correlation between FEV₁ and FVC (r = 0.81), FEV₁ and TLC (r = 0.61), and FVC and TLC (r = 0.80), and a lack of correlation between FEV₁ and DL_CO, we developed a pretransplant lung function score based on pretransplant FEV₁ and DL_CO to determine the extent of pulmonary compromise before transplant. Multivariate analysis indicated that higher pretransplant lung function scores are associated with a significant increased risk for developing early respiratory failure (category II hazard ratio [HR], 1.4; category III HR, 2.2; category IV HR, 3.1; p < 0.001) and death (category II HR, 1.2; category III HR, 2.2; category IV HR, 2.7; p < 0.005). Conclusions: These results suggest that not only does compromised pretransplant lung function contribute to the risk for development of early respiratory failure and mortality but this risk may be estimated before transplant by grading the extent of FEV₁ and DL_CO compromise.

Key Words: bone marrow transplantation • mortality • pretransplant pulmonary function tests • respiratory failure

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