Longitudinal Changes in Pulmonary Function Following Bone Marrow Transplantation: Effect of GVHD

Longitudinal Changes in Pulmonary Function Following Bone Marrow Transplantation: Effect of GVHDEffect of GVHD
There was no effect of AGVHD on changes in pulmonary function. In contrast, CGVHD was associated with a mean loss of 4.45 percent predicted FEVx per year. Patients without CGVHD had a mean gain of 4.3 percent predicted FEVX per year (p = 0.02) (Table 5). There was no significant difference in rate of change per year of percent predicted FVC or Dsb. Patients with CGVHD had a yearly rate of loss of FEVj of 116 ml/year in contrast to patients without CGVHD who had a net gain of 92 ml/year of FEVi (p = 0.10). Patients with and without CGVHD had a yearly gain of FVC of 6 and 165 ml/year, respectively. Progressive loss of FEVi with stable FVC is consistent with the development of airway obstruction in association with CGVHD. cfm-online-shop.com

Effect of GVHD Prophylactic Regimen
Several prophylactic regimens were used to prevent the development of GVHD in this cohort. The majority of patients received cyclosporine-A alone or in combination with cyclophosphamide or methylpred-nisolone. There were no significant differences among various prophylactic regimens in the rate of change of lung function (Table 4) when expressed as percent predicted (ie, adjusted for age, height and sex).
Discussion
The most important results of this study were the well preserved spirometric values in our patient population following bone marrow transplantation. There was, however, a progressive fall in Dsb averaging 11.9 percent per year. This population consisted largely of young patients without previous pulmonary disease and normal baseline pulmonary function. There was considerable variability and evidence of greater loss of pulmonary function among certain identifiable subpopulations of patients following bone marrow transplantation. Patients with a pre-bone marrow transplant diagnosis of CML showed the development of a gas transfer defect following marrow transplantation as indicated by the falling percent predicted Dsb of 27.5 percent per year. The significantly greater loss in Dsb in patients with CML cannot be attributed to greater cytotoxic therapy prior to bone marrow transplantation since in general CML patients received only oral hydroxyurea or busulfan in modest doses compared with patients with acute leukemia who received very high doses of chemotherapy.
Table 5—Effect of CGVHD: Rate of Change per Year (Percent Predicted)

CGVHD No. FEV, FVC Dsb
Negative 25 4.3± 12.5 — 3.7 ± 13.0 -11.2 ±26.0 (n = 21 [Neg])
Positive 9 — 4.4±8.1 0.5±6.9 -13.5 ±15.9 (n = 8 [Pbs])
p value 0.02 NS NS

Category: Bone Marrow Transplantation

Tags: bone marrow transplantation, obstructive airway, Pulmonary function