Lung function changes after allogenic bone marrow transplantation.

Abstract

The lung function of 21 patients with leukaemia (11 with acute myeloid leukaemia, six with acute lymphatic leukaemia, four with chronic myeloid leukaemia) and of five with severe aplastic anaemia was tested before and after allogenic bone marrow transplantation. Vital capacity (VC) was lowered in patients with leukaemia before transplantation. VC and FEV, fell significantly after transplantation. Residual volume (RV) and RV as a percentage of total lung capacity (RV % TLC) were already increased and rose significantly after transplantation. Patients with severe aplastic anaemia had noticeably increased RV and RV % TLC, values that did not change after transplantation. In contrast to the patients with aplastic anaemia, the patients with leukaemia had significantly reduced VC, RV, RV % TLC, and FEV1 before and after transplantation. The specific airway resistance (sRaw) was raised significantly before and after transplantation in the leukaemic patients. In addition, transfer coefficient (Kco) fell significantly more after transplantation in the patients with leukaemia than in those with severe aplastic anaemia. In three patients with histologically established obstructive bronchiolitis in conjunction with chronic graft versus host disease after transplantation, VC, FEV, and FEV, % VC fell, while RV, RV % TLC, and sRaw rose; Kco was far below normal. On the basis of these findings it is concluded that in patients with leukaemia obstructive disorders of ventilation develop or, if they are already present, worsen. In patients with severe aplastic anaemia lung function was not impaired in the early phase after transplantation. These differences are probably due to the more intensive immunosuppressive and cytotoxic preparatory regimen before transplantation in the leukaemic patients. Obstructive bronchiolitis, a complication of graft versus host disease, first manifests itself in a typical rise in specific airway resistance and must be treated early.

Association of pulmonary function testing abnormalities and severe veno-occlusive disease of the liver after marrow transplantation

“…[1][2][3][4][5][6][7][8][9] Most studies have focused on measures of airflow (FEV 1 and FVC) as predictors of pneumonia. At this center, D L CO c and P(A-a)O 2 were independently associated with death when entered in a multivariate proportional hazards model controlling for other covariates associated with mortality after transplant, such as age, HLA-nonidentical donor marrow, active malignancy at transplant, and primary diagnosis.…”

Pulmonary function abnormalities after allogeneic marrow transplantation: a systematic review and assessment of an existing predictive instrument

“…Twelve studies had fewer than 50 patients, 7,[22][23][24][25][26][27][28][31][32][33][34] four studies had 50-99 patients, 3,11,29,30 three studies had 100 or more patients, 4,5,16 and one study did not clearly state the number of patients with pre-and post-BMT PFTs. 3 Seven studies were limited to adults, 4,7,16,25,26,30,32 six studied only children, 6,24,27,28,31,34 five studied adults and children, 3,5,22,23,33 and the remaining two did not specify patient ages. 11,29 Conditioning regimens commonly included cyclophosphamide, busulfan and total body irradiation (TBI).…”

“…Twenty studies presented PFT results in patients both before and at least 3 months after BMT and were reviewed in full. [3][4][5][6][7]11,16,[22][23][24][25][26][27][28][29][30][31][32][33][34] These reports provided information on up to 1786 allogeneic BMT patients. The exact number is unclear due to overlap in patient samples between studies, and incomplete description of numbers of patients with PFT data and allo-vs autoBMT.…”

“…Most restrictive changes were subclinical, but the relatively uncommon obstructive changes, were accompanied by significant symptoms. [5][6][7]33 Risk factors for the development of PFT abnormalities were identified in several studies, listed in Table 1. Obstruction was associated with GVHD in 12 studies, [4][5][6][7]11,16,22,26,29,30,32,33 increasing age at transplant in pediatric patients in two studies, 6,31 and increasing HLA mismatch, 6 leukemia, 33 busulfan conditioning 30 and alveolar capillary permeability, 25 in one study each.…”

“…[5][6][7]33 Risk factors for the development of PFT abnormalities were identified in several studies, listed in Table 1. Obstruction was associated with GVHD in 12 studies, [4][5][6][7]11,16,22,26,29,30,32,33 increasing age at transplant in pediatric patients in two studies, 6,31 and increasing HLA mismatch, 6 leukemia, 33 busulfan conditioning 30 and alveolar capillary permeability, 25 in one study each. Restriction was associated with GVHD in four studies, 16,22,23,30 and TBI, 16 single fraction TBI, 11 infection, 23 busulfan conditioning, 30 CMV seropositivity, 24 increasing age among pediatric patients 31 and age less than 18 years overall, 23 in one study each.…”