Pulmonary function testing prior to hematopoietic stem cell transplantation

Abstract

Summary:The pretransplant pulmonary function test plays an important role in the management of noninfectious pulmonary complications after hematopoietic stem cell transplantation (HCT). Although these tests are widely used as standard preoperative assessments in the nontransplant population, common conditions associated with the HCT patient requires that particular attention be given to interpretation of pulmonary function testing (PFT) results, such as comparison of serial pulmonary function tests and evaluation of the diffusion capacity. Although their utility in helping to predict the likelihood of developing post transplant pulmonary complications and mortality is not well established, current data indicate that pretransplant PFTs are important as a reference for the interpretation of post transplant PFTs and for identifying patients at high risk for developing pulmonary complications and/or mortality after HCT. Future studies of pretransplant pulmonary function should consider the advances in HCT, so that pretransplant PFTs will become a useful tool in pretransplant risk assessment and help the transplant oncologist to determine the most appropriate conditioning regimen for a patient with compromised lung function.

Testes de função pulmonar e mortalidade após o transplante de células-tronco hematopoiéticas

“…These premises were emphasized by Chien et al in their review of PFTs in HSCT. (10) Age and losses due to death within the first 100 days after transplantation significantly reduced the number of patients in our final sample. The increase in the number of autologous HSCTs, rather than in the number of allogenic HSCTs, in the two years when the patients were included also contributed to the smaller final sample size, in addition to complicating comparisons with most other studies, which were retrospective and included recipients of autologous or allogenic transplantation.…”

“…Although there are many studies on this subject in the literature, questions remain about the true usefulness of PFTs. (10) There has been only one retrospective study conducted in Brazil, undertaken at a major center for HSCT, in which spirometry alone was used in the pre-and post-HSCT assessment of pulmonary function. in patients who develop severe respiratory failure and require mechanical ventilation.…”

“…(8) Some authors suggest that PFTs should be performed more frequently in the first two years after HSCT, especially in patients with chronic graftversus-host disease (GVHD). (9)(10)(11) It is believed that performing PFTs more frequently after HSCT would not only allow the identification of NIPCs but could enable early preventive and therapeutic interventions in at-risk patients. (8,12) The objective of the present study was to prospectively investigate whether the PFT results obtained prior to and after HSCT are associated with post-transplant mortality and post-transplant NIPCs, as well as to determine whether abnormal PFT results obtained prior to HSCT are associated with changes in the management of HSCT.…”

“…(3)(4)(5)(6)(7) The pulmonary function tests (PFTs) used in the assessment and follow-up of patients submitted to HSCT include measurement of lung volumes, spirometry, and measurement of DLCO. (2,(8)(9)(10) Although PFTs are internationally adopted for pre-and post-HSCT assessment, their true usefulness and the ideal interval between HSCT and PFTs remain debatable. (6,11) The current recommendation is that PFTs be performed prior to HSCT and one year after HSCT.…”

Comorbidity indices in hematopoietic stem cell transplantation: a new report card

“…Other investigators, however, have failed to demonstrate that pre-transplant lung function studies are capable of predicting patient outcomes. [12][13][14] Of all single organ comorbidities studied, the presence of abnormal liver function tests (primarily elevated serum transaminases) has been the most predictive of tissue specific toxicity post transplant. Thus, patients with elevated transaminases have a three-to six-fold increased risk of developing moderate to severe hepatic veno-occlusive disease after transplant.…”