Clinical Implications of Pulmonary Function Tests in Allogeneic Stem Cell Recipients.

Abstract 4297

Pulmonary dysfunction is one of major causes of morbidity and mortality in the allogeneic stem cell recipients. From Jun 2002 to Oct 2008, we retrospectively analyzed pulmonary functions (PF) in 116 consecutive patients who received allogeneic stem cell transplantation (SCT) and survived at least 3 months after transplantation. Pulmonary function test was performed at baseline, 3 months, 6 months, 1 year, and annually thereafter. Ventilatory capacity was measured by forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC ratio. Lung volume measurements included total lung capacity (TLC), residual volume (RV), and RV/TLC ratio. Diffusion capacity for carbon monoxide (DLCO) was determined with correction for hemoglobin concentration. Of the 116 patients, 63 patients were followed more than 1 year. The patients with acute graft-versus-host disease (GVHD; p=0.011), chronic GVHD (p=0.009), or CMV infection (p=0.410) showed a decline of FEV1 and FEV1/FVC after 1 year of transplantation. TLC and RV/TLC also showed an increasing tendency after 1 year of transplantation which reflected abnormal ventilatory pulmonary function. Conditioning intensity, unrelated donor type, stem cell dose did not adversely affect the pulmonary function. We calculated the lung function score (defined as FEV1 score plus DLCO score; NIH chronic GVHD consensus Project, 2003) at 1 year of transplant and compared it from that of baseline to identify the factors affecting late pulmonary dysfunction. In the multivariate analysis, extensive cGVHD (OR=3.692, 95% CI=1.154-11.818; p=0.028) and previous CMV infection (OR=5.356, 95% CI=1.311-21.882; p=0.019) negatively affected on late pulmonary function. In addition, the patients with early decline of FEV1 more than 10% at 3 months compared to baseline showed a higher incidence of cGVHD during follow-up (p=0.016). In conclusion, patients who had extensive cGVHD or CMV infection had a higher possibility of late pulmonary dysfunction and decline of FEV1 at 3 months of transplantation reflected the development of cGVHD.