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Post-Transplant Complications

Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation

Bone Marrow Transplantation volume 33, pages 509–517 (2004)Cite this article

Summary:

We studied long-term pulmonary function testing (PFT) in a retrospective cohort of 6-month survivors of allogeneic marrow transplant (BMT) between 1980 and 1997. Of 593 patients, 73, 71 and 65% had adequate data to assess for obstruction, restriction and diffusion impairments respectively. Over 5 years, mean declines in 1-s forced expiratory volume/forced vital capacity (FEV1/FVC), total lung capacity (TLC) and diffusion were 4, 7 and 17%, respectively. TLC and diffusion tended to subsequently increase. In all, 6, 12 and 35% of patients met criteria for obstruction, restriction and impaired diffusion, respectively. Obstruction was less common in recent transplants (5 vs 15%, P=0.004), while restriction and diffusion impairment rates remained stable. There was significantly greater mortality with obstruction (HR 2.0 (1.04–3.95)), and a nonstatistically significant higher mortality rate with restriction (HR 1.6 (0.95–2.75)), but not with impaired diffusion (HR=0.99 (0.65–1.50)). cGVHD (OR 16.7 (2.2–129.8)) and busulfan (OR 2.9 (1.01–8.24)) were associated with obstruction. Marrow from nonsibling or mismatched donors (OR 4.9 (2.2–10.7)) was associated with restriction. In summary, after BMT, decreased diffusion capacity is common and benign; obstruction has decreased in frequency, is rare without cGVHD, and is associated with mortality; nonsibling and mismatched donor are risk factors for restriction.

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Acknowledgements

We thank Dr Smita Pakhale, Ms Jessica Wright and the late Dr Usha Senitharajah for help with data collection and entry, and Dr Robert Hyland and Dr Michael Hutcheon for sharing their content expertise. Dr Marras is a Canadian Institutes of Health Research and Canadian Thoracic Society postdoctoral fellow and University of Toronto, Department of Medicine clinician scientist trainee. Dr Laupacis is a Senior Scientist of the Canadian Institutes of Health Research. The Ontario Thoracic Society supported this project.

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Authors and Affiliations

  1. Joint Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

    T K Marras & C K Chan

  2. Department of Medicine, Allogeneic Bone Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada

    J H Lipton & H A Messner

  3. Department of Research Design and Biostatistics, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    J P Szalai

  4. Institute for Clinical Evaluative Sciences, Toronto, Canada

    A Laupacis

  5. Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    A Laupacis

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  1. T K Marras
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  5. J P Szalai
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  6. A Laupacis
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Correspondence to T K Marras.

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Marras, T., Chan, C., Lipton, J. et al. Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation. Bone Marrow Transplant 33, 509–517 (2004). https://doi.org/10.1038/sj.bmt.1704377

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