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Published ahead of print on March 20, 2003, doi:10.1164/rccm.200212-1468OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 2, July 2003, 208-214

A more recent version of this article appeared on July 15, 2003
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Submitted on December 16, 2002
Accepted on March 18, 2003

Airflow obstruction after myeloablative allogeneic hematopoietic stem cell transplantation

Jason W Chien1*, Paul J Martin1, Ted A Gooley1, Mary E Flowers1, Susan R Heckbert2, W. Garrett Nichols1, and Joan G Clark1

1 Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 2 Epidemiology, University of Washington, Seattle, WA, USA

* To whom correspondence should be addressed. E-mail: jchien{at}fhcrc.org.

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




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