Pre-Hematopoietic Stem Cell Transplantation Lung Function and Pulmonary Complications in Children Article Swipe
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· 2015
· Open Access
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· DOI: https://doi.org/10.1016/j.bbmt.2014.11.129
· OA: W2317123883
Pulmonary complications are a significant cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation. The relationship between pre-transplant pulmonary function tests (PFT) and development of post-transplant pulmonary complications in children was studied. This is a retrospective single institution cohort study of 410 patients who underwent pre-transplant PFT and were followed up to 10 years post-transplant. Pulmonary complications were observed in 174 (42%) patients. Children with pulmonary complications had significantly lower FEF25-75% (P = 0.02) derived using conventional predicted equations for age, and the Global Lung Initiative-2012 predicted equations (P = 0.01). T-cell depletion (P = 0.001), acute grade 3-4 graft-versus-host disease (GVHD; P = 0.008), and chronic GVHD (P = 0.01) increased risk for pulmonary complications. Patients who had pulmonary complications had a 2.8-fold increased risk of mortality (P < 0.0001). The cumulative incidence of death due to pulmonary complications was significantly higher in children who had low lung volumes, functional residual capacity (FRC) < 50% (P = 0.005), total lung capacity (TLC) < 50% (P = 0.0002), residual volume (RV) < 50% (P = 0.007), and T-cell depletion (P = 0.01). Lower forced expiratory volume in one second (FEV1; P = 0.0005), forced vital capacity (FVC; P = 0.0005), TLC (P < 0.0001), RV < 50% (P = 0.01), and restrictive lung disease (RLD; P= 0.01) predicted worse overall survival. Abnormal pre-transplant PFT significantly increased risk post-transplant. These patients may benefit from modified transplant strategies to reduce morbidity and mortality.
