Source: Annual Congress 2008 - Lung and bone marrow transplantation: miscellaneous

Abstract

Airflow obstruction following haematopoietic stem cell or bone marrow transplantation (HSCT/BMT) usually occurs between month 3 and month 12, and is typically associated with graft versus host disease (GVHD). With regard to pulmonary function tests (PFT), it is defined as decrease in forced expiratory vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), or significant reduction of the ratio of FEV₁ by FVC (FEV₁/FVC). The incidence of early airflow obstruction in patients undergoing HSCT varies between 6 and 26% and is strongly associated with high mortality. Much less is known on the development of PFT in later phases of transplantation.
A total of 45 patients (mean follow-up: 56.8 months) undergoing either BMT or HSCT for chronic myeloid leukaemia (CML) were retrospectively analysed. For conditioning therapy chemotherapy with Cyclophosphamide (CYC) + radiation was used in 19 patients compared to CYC + Busulfan in 13 patients. Prevalence and onset of the decline of FVC, FEV₁, and FEV₁/FVC were evaluated.
All patients demonstrated a regular course following transplantation. The decline of all PFT values were significant (FVC -620ml ; p<0.005/ FEV₁ -590ml; p<0.001/ FEV₁/FVC -4%; p=0.049). Regarding the Busulfan treated subgroup, the decline was more rigorously (FVC -1300ml; p<0.004/ FEV₁ -970ml; p<0.003/ FEV₁/FVC -9%; p=0.055) compared to the radiation group.
The decline of PFT values occurred years after transplantation in patients with a regular clinical course demonstrating no significant pulmonary GVHD. These findings may help to identify those patients at risk for development of late chronic airflow obstruction following transplantation.

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C. Lambers, B. Marzluf, C. Hussein, S. Woehrer, A. Boehm, P. Kahls, W. Rabitsch (Vienna, Austria; Zürich, Switzerland). Long time decline of lung function in patients with chronic myeloid leukemia after allogeneic stem cell transplantation. Eur Respir J 2008; 32: Suppl. 52, 1633

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