Longitudinal Changes in Pulmonary Function Following Bone Marrow Transplantation: Transplantation Procedures

Transplantation Procedures
Patients with hematologic malignancies were generally treated with a preparative regimen of busulfan plus cyclophosphamide or cyclophosphamide plus TBI as previously described. Both busulfan (16 mg/kg) and cyclophosphamide (200 mg/kg) were given in divided doses during four days; TBI was given at 5 to 7.5 rads/min from a cobalt 60 source. All patients received 300 rads given daily for four consecutive days with lung shielding with six half-value layers on the third day. Ail patients with severe AP were treated with cyclophosphamide alone, as previously described. Graft-us-host disease prophylaxis consisted of cyclosporine-A or steroids in combination with either cyclophosphamide or cyclosporine-A as previously described.

Pulmonary Function Testing
All patients received baseline pulmonary function studies approximately 14 days prior to bone marrow transplantation. Thereafter, follow-up pulmonary function studies were obtained at six months, 12 months and annually. Forced expiratory spirometry was performed in all patients with a Stead-Wells spirometer (Collins, Braintree, MA) according to standardized techniques. Lung volumes were measured by helium dilution technique and Dsb was performed. In the Dsb measurement, no correction was made for C02 absorption. The Dsb values were corrected for hemoglobin concentration by using the corrections of Cotes et al.® Hemoglobin concentrations used for correction of Dsb were obtained on the same day as pulmonary function testing. Pulmonary function test results were expressed as absolute values as well as percent predicted values. Predicted values for pulmonary functions were those utilized in the pulmonary function laboratory at the Johns Hopkins Hospital.

Data Analyses
Initial and follow-up FEV,, FVC, and Dsb tests were done for each patient at both the initial and final visits. Rate of change of a test was obtained by dividing the absolute change between the initial test value and the longest follow-up test result available by the interval between the tests and expressed as change per year. Rates of change of pulmonary function were compared for subgroups with different clinical and demographic characteristics including sex, smoking status, diagnosis, preparative drug regimen, ACVHD, CGVHD and GVHD prophylactic regimen. Statistical analysis was performed by use of Students t test and one-way analysis of variance.

Category: Bone Marrow Transplantation

Tags: bone marrow transplantation, obstructive airway, Pulmonary function