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

Abstract

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.