Longitudinal Changes in Pulmonary Function Following Bone Marrow Transplantation: Overall Changes in Pulmonary Function
Overall Changes in Pulmonary Function
Baseline pulmonary function studies for the entire group are shown in Table 2. These results are most notable for the excellent pulmonary function in the patient population prior to transplantation. Mean percent predicted FEVi was 91.6 percent with a mean percent predicted FVC of 94.9 percent. When corrected for hemoglobin, percent predicted Dsb averaged 83.7 percent for the entire population. Longitudinal changes in pulmonary (unction are shown in Figure 1 for the entire group. Follow-up spirometric values were available in all 34 patients, but there were five patients without complete Dsb data. Thirty-two patients had baseline diffusion studies, but adequate follow-up studies were available in only 29. Mean rates of change of spirometric values were rather small, averaging 2.1 percent for percent predicted FEVi and 2.6 percent for percent predicted FVC per year. The Dsb fell more rapidly, 1.57 ml/m/mm Hg or 11.9 percent predicted per year. ventolin inhalers
Effect of Pre-bone Marrow Transplant Diagnosis
The effect of pre-bone marrow transplant diagnosis on longitudinal changes in pulmonary function is shown in Table 3. Follow-up spirometry revealed small changes in percent predicted FEVj and FVC for all diagnostic groups longitudinally following bone marrow transplantation. Analysis of variance failed to reveal any significant difference between the rate of change in spirometric values among the various disease groups. The patients with CML had a marked loss in Dsb with an average loss of 27 percent predicted Dsb over a years time. This value was highly significant with a probability of <0.001 in contrast to the rates of change observed for patients with ALL, AML and AP.
Effect of Preparative Regimen
Similar results were obtained in regard to the effect of regimen used to prepare patients for transplantation (Table 4). No significant differences were noted on followup spirometry in patients who had received cyclophosphamide plus busulfan, TBI and cyclophosphamide, or cyclophosphamide alone. In terms of gas diffusion, patients receiving cyclophosphamide plus busulfan and patients receiving TBI plus cyclophosphamide had a mean loss of pulmonary function of 4.6 and 19.2 percent per year, respectively. In contrast, patients receiving cyclophosphamide only had a 15.7 percent yearly gain in percent predicted hemoglobin corrected Dsb (p <0.005). All patients who received cyclophosphamide only had a diagnosis of AP and thus received less intensive cytoreductive therapy than other patient groups. Comparison of patient groups receiving cyclophosphamide plus busulfan vs TBI plus cyclophosphamide in terms of rate of change per year percent predicted Dsb corrected was not significantly different.
Table 2—Baseline Pulmonary Function Prior to Bone Marrow Transplantation
|Test||No.||Absolute Value (Mean ± SD)||Percent Predicted (Mean ± SD)|
|FVC||34||4.32 ±1.25 (L)||94.9 ±14.5 (%)|
|FEVj||34||3.58 ±0.93 (L)||91.6± 12.3 (%)|
|Dsb||32||25.1 ±7.58 (ml/m/mm Hg)||83.7±17.7 (%)|
Table 3—Effect of Pre-bone Marrow Transplant Diagnosis Bate of Change per Year (Percent Predicted) (mean + SD)
|ALL||8||— 3.06 ±4.4||-1.19±3.8||-3.90 ±12.6 (n = 8)|
|AML||8||+ 7.97 ±19.8||+ 3.05± 11.8||-6.54 ±16.8 (n = 6)|
|AP||4||5.01 ±7.6||-2.72 ±13.7||18.68 ±30.6 (n = 3)|
|CML||14||0.94± 11.1||6.08 ±23.0||-27.48 ±18.5 (n = 12)|
Table 4—Effect of Preparative Regimen: Rate of Change per Year (Percent Predicted)
|Cyclophosphamide, Busulfan||7||9.7±21.0||4.1 ±12.5||— 4.6± 15.6(n — 5)|
|Cyclophosphamide, TBI||23||— 0.5±9.5||3.2± 12.1||-19.2 ±17.9 (n = 20)|
|Cyclophosphamide||4||3.1 ±7.8||— 2.5± 11.9||15.7±22.5 (n = 4)|
Figure 1. Mean rate of change per year in pulmonary (unction following bone marrow transplantation for the entire study population (mean + SD). N = 34 for FEV„ percent predicted FEV,, FVC; N = 29 for AVL, Dsb, percent predicted Dsb. AVL=alveolar volume; PP = percent predicted.