BACKGROUND: The success of allogeneic stem cell transplantation (SCT) is limited by transplant-related mortality (TRM). Death from pulmonary causes is a major contributor to TRM. Several factors influence TRM from pulmonary causes. We have analyzed the effect of cigarette smoking on pulmonary related TRM.

METHODS: From January 2000 through April 2006 240 patients (pts) underwent allogeneic related or unrelated SCT. Diagnosis included ALL in 22 pts, AML in 90 pts, CLL in 11 pts, CML in 11 pts, Lymphoma in 49 pts, MDS in 29 pts, MM in 9 pts, SSA in 4 pts, solid tumors in 5 pts, other in 4 pts; median age of the pts was 50 years (range 18–70); 148 were males and 92 females; 48 pts received a reduced intensity regimen and 192 an ablative regimen; 117 pts received TBI; 123 pts were non-smokers (Group I) and 117 pts smokers. Amongst the smokers 86 pts provided pack/year information. In this group 46 pts (Group II) had a pack/year history < 30 and 40 pts (Group III) of ≥ 30.

RESULTS: 70/123 pts in Group I are deceased with 44% surviving. In this group causes of death included disease progression/relapse in 17 pts, infection in 17 pts, organ failure in 13 pts, GVHD in 11 pts, other in 3 pts and pulmonary related TRM in 8 pts (6.5 ± 4%). 29/46 pts in Group II are deceased with 36% surviving. In this group causes of death included diseaseprogression/relapse in 10 pts, infection in 8 pts, organ failure in 1pt, GVHD in 3 pts, other in 2 pts and pulmonary related TRM in 5 pts (10.9 ± 9%). 31/40 pts in Group III are deceased with 22% surviving. In this group causes of death included disease progression/relapse in 11 pts, infection in 6 pts, organ failure in 5 pts, GVHD in 2 pts, other in 2 pts and pulmonary related TRM in 5 pts (12.5 ± 10 %).

CONCLUSION: Smoking contributes to transplant-related mortality from pulmonary causes after allogeneic stem cell transplantation in a dose-related manner. In future analysis the interaction between smoking and other variables will be explored.

Smoking and Outcomes

Pt GroupSurviving Pts (%)Deceased Pts (%)Pulmonary TRM
Group I ( n=123) 44% 56% 6.5% 
Group Ii (n=46) 36% 64% 10.9% 
Group III ( n=40) 22% 78% 12.5% 
Pt GroupSurviving Pts (%)Deceased Pts (%)Pulmonary TRM
Group I ( n=123) 44% 56% 6.5% 
Group Ii (n=46) 36% 64% 10.9% 
Group III ( n=40) 22% 78% 12.5% 
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Topics:
allogeneic stem cell transplant, lung, smoking, transplantation, brachial plexus neuritis, graft-versus-host disease, infections, organ failure, disease progression, lymphoma

Disclosure: No relevant conflicts of interest to declare.

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2006, The American Society of Hematology
2006
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