Longitudinal Changes in Pulmonary Function Following Bone Marrow Transplantation: Results
Demographic and Clinical Features
The group consisted of 34 patients on whom serial pulmonary function testing was available. Five patients did not have technically adequate Dsb determinations at either baseline or follow up and were not included in the data analysis for this variable. Characteristics of the transplant recipients who were followed up elsewhere and our study population were compared. There were no significant differences in age at transplant, survival, sex, smoking status, diagnosis and preparative regimen. Nonstudy patients included a statistically significant (p = 0.03) excess of autologous transplants with a correspondingly significant difference in GVH prophylactic regimen. Reading here
The study population had a mean age of 27.5 years. The oldest patient studied was 50 years of age. Average follow up time was approximately two years, with a mean of 630.9 (SD, 629; range, 190 to 1,136) days. There were 20 male and 14 female patients in the study cohort. Twenty-one patients had never smoked, eight patients were current cigarette smokers, and five were former smokers. The diagnostic groups for which patients underwent bone marrow transplantation included hematologic malignancies as well as AP There were eight patients with a diagnosis of ALL, eight with AML, 14 with CML and four with AP. Thirty-two patients had allogeneic bone marrow transplantation and two patients had autologous transplants. The regimen to prepare patients for marrow grafting was a combination of busulfan and cyclophosphamide in seven patients, all of whom had AML. Twenty-three patients received TBI in combination with cyclophosphamide. This group included patients with ALL as well as CML. Four patients with AP received cyclophosphamide alone. The majority of patients received cyclosporine-A alone as GVHD prophylaxis, with smaller numbers of patients receiving cyclosporine-A in combination with cyclophosphamide and/or meth-ylprednisolone. Two patients who had autologous transplants (Table 1) received no GVHD prophylaxis.
Of the 34 patients studied, eight developed AGVHD which in seven was graded in severity as grade 1 on a scale of 0 to 4. A single patient had AGVHD of grade 2 severity. Two patients developed interstitial pneumonitis, one appearing at 101 days posttransplantation and thought to be secondary to CMV and the second at 161 days posttransplantation of unknown origin. Nine patients developed CGVHD, with 25 being free of the disorder.
Table 1—Effect of GVHD Prophylactic Regimen: Rate of Change per Year (Percent Predicted)
|Cyclosporine-A||19||4.2± 14.7||1.8± 12.3||-10.4 ±24.4 (n = 16)|
|Cyclosporine-A,cyclophosphamide||5||— 2.6± 14.0||4.6± 18.5||-31.5 ±15.0 (n = 5)|
|Cyclosporine-A,methylprednisolone||8||0.2±4.6||1.49 ±4.3||-0.3±5.8 (n = 7)|
|None||2||— 2.3± 16.6||9.4 ±19.6||-17.6 ±0.0 (n = l)|