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Hb-adjusted DLCO with GLI reference predicts long-term survival after HSCT in children

Bone Marrow Transplantation volume 56, pages 1929–1936 (2021)Cite this article

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Abstract

This study aimed to evaluate the pretransplant diffusing capacity as a predictor of outcomes in pediatric allogeneic hematopoietic stem cell transplantation (allo-HSCT). Retrospective cohort study of 176 children followed outcomes for 5 years after allo-HSCT. We conducted an analysis of PFTs include spirometry, body plethysmography, and diffusing capacity prior to allo-HSCT. We analyzed the probabilities of overall survival (OS), disease-related mortality (DRM), and non-relapse mortality (NRM). Of all carbon monoxide diffusing capacity (DLCO) parameters obtained using the Global Lung Function Initiative (GLI)-2017, univariate analysis showed that the grade 3, 4 of DLCOadj and Category III, IV of LFS significantly increase NRM (p = 0.003 and p = 0.008). Multivariate analysis indicated that a significant increase in the risk of NRM is associated with grades 3, 4 DLCOadj (hazard ratio [HR] = 4.90, p = 0.020). Kaplan–Meier analyses showed that a significant stepwise increase in NRM was observed with both worse pretransplant DLCOadj grades and LFS categories (p < 0.001 and p = 0.003). A compromised pretransplant diffusing capacity and a high LFS significantly increase the risk of NRM. Especially, DLCOadj before transplantation can be used as an important predictor of NRM after allo-HSCT in children with malignancy.

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References

  1. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106:2912–9.

    Article  CAS  Google Scholar 

  2. Cheng GS. Pulmonary function and pretransplant evaluation of the hematopoietic cell transplant candidate. Clin Chest Med. 2017;38:307–16.

    Article  Google Scholar 

  3. Parimon T, Madtes DK, Au DH, Clark JG, Chien JW. Pretransplant lung function, respiratory failure, and mortality after stem cell transplantation. Am J Respir Crit Care Med. 2005;172:384–90.

    Article  Google Scholar 

  4. Crawford SW, Fisher L. Predictive value of pulmonary function tests before marrow transplantation. Chest. 1992;101:1257–64.

    Article  CAS  Google Scholar 

  5. Chien JW, Sullivan KM. Carbon monoxide diffusion capacity: how low can you go for hematopoietic cell transplantation eligibility? Biol Blood Marrow Transpl. 2009;15:447–53.

    Article  CAS  Google Scholar 

  6. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.

    Article  CAS  Google Scholar 

  7. Graham BL, Brusasco V, Burgos F, Cooper BG, Jensen R, Kendrick A, et al. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J. 2017;49:1600016.

    Article  Google Scholar 

  8. Stanojevic S, Graham BL, Cooper BG, Thompson BR, Carter KW, Francis RW, et al. Official ERS technical standards: Global Lung Function Initiative reference values for the carbon monoxide transfer factor for Caucasians. Eur Respir J. 2017;50:1700010.

    Article  Google Scholar 

  9. Cotes JE, Chinn DJ, Quanjer PH, Roca J, Yernault JC. Standardization of the measurement of transfer factor (diffusing capacity). Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993;16:41–52.

    Article  CAS  Google Scholar 

  10. Longato E, Vettoretti M, Di Camillo B. A practical perspective on the concordance index for the evaluation and selection of prognostic time-to-event models. J Biomed Inform. 2020;108:103496.

    Article  Google Scholar 

  11. Neder JA, Berton DC, Muller PT, O’Donnell DE. Incorporating lung diffusing capacity for carbon monoxide in clinical decision making in chest medicine. Clin Chest Med. 2019;40:285–305.

    Article  Google Scholar 

  12. Polgar G. Pulmonary function tests in children. J Pediatr. 1979;95:168–70.

    Article  CAS  Google Scholar 

  13. Crapo RO, Morris AH. Standardized single breath normal values for carbon monoxide diffusing capacity. Am Rev Respir Dis. 1981;123:185–9.

    CAS  PubMed  Google Scholar 

  14. Miller A, Thornton JC, Warshaw R, Anderson H, Teirstein AS, Selikoff IJ. Single breath diffusing capacity in a representative sample of the population of Michigan, a large industrial state. Predicted values, lower limits of normal, and frequencies of abnormality by smoking history. Am Rev Respir Dis. 1983;127:270–7.

    CAS  PubMed  Google Scholar 

  15. Cotes JE, Dabbs JM, Elwood PC, Hall AM, McDonald A, Saunders MJ. Iron-deficiency anaemia: its effect on transfer factor for the lung (diffusiong capacity) and ventilation and cardiac frequency during sub-maximal exercise. Clin Sci. 1972;42:325–35.

    Article  CAS  Google Scholar 

  16. Chien JW, Madtes DK, Clark JG. Pulmonary function testing prior to hematopoietic stem cell transplantation. Bone Marrow Transpl. 2005;35:429–35.

    Article  CAS  Google Scholar 

  17. Marrades RM, Diaz O, Roca J, Campistol JM, Torregrosa JV, Barbera JA, et al. Adjustment of DLCO for hemoglobin concentration. Am J Respir Crit Care Med. 1997;155:236–41.

    Article  CAS  Google Scholar 

  18. Wuyts WA, Agostini C, Antoniou KM, Bouros D, Chambers RC, Cottin V, et al. The pathogenesis of pulmonary fibrosis: a moving target. Eur Respir J. 2013;41:1207–18.

    Article  CAS  Google Scholar 

  19. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–68.

    Article  CAS  Google Scholar 

  20. Johnson DC. Importance of adjusting carbon monoxide diffusing capacity (DLCO) and carbon monoxide transfer coefficient (KCO) for alveolar volume. Respir Med. 2000;94:28–37.

    Article  CAS  Google Scholar 

  21. Srinivasan A, Srinivasan S, Sunthankar S, Sunkara A, Kang G, Stokes DC, et al. Pre-hematopoietic stem cell transplant lung function and pulmonary complications in children. Ann Am Thorac Soc. 2014;11:1576–85.

    Article  Google Scholar 

  22. Chang PMH, Chiou TJ, Yen CC, Hsiao LT, Liu JH, Chen PM. Diffusion capacity predicts long-term survival after allogeneic bone marrow transplantation for acute lymphoblastic leukemia. J Chin Med Assoc. 2008;71:234–40.

    Article  Google Scholar 

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Acknowledgements

We thank the all the staff members of the collaborating division of Hematology and Oncology, Department of Pediatrics, College of Medicine, The Catholic University of Korea.

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  1. These authors contributed equally: Jong-seo Yoon, Cho Bin

Authors and Affiliations

  1. Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hye Jin Lee, Kyunghoon Kim, Seong koo Kim, Jae Wook Lee, Jong-seo Yoon, Nack-Gyun Chung & Cho Bin

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  1. Hye Jin Lee
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Contributions

J-sY conceived the research idea. KhK, SkK, JWL, J-sY, NGC, and BC were responsible for the diagnosis and treatment of the patients and collected the clinical and laboratory data. All authors reviewed and approved the final version.

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Correspondence to Jong-seo Yoon or Cho Bin.

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Lee, H.J., Kim, K., Kim, S.k. et al. Hb-adjusted DLCO with GLI reference predicts long-term survival after HSCT in children. Bone Marrow Transplant 56, 1929–1936 (2021). https://doi.org/10.1038/s41409-020-01202-9

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