Longitudinal Changes in Pulmonary Function Following Bone Marrow Transplantation

Longitudinal Changes in Pulmonary Function Following Bone Marrow TransplantationBone marrow transplantation offers patients with a variety of malignant and nonmalignant diseases the chance for potentially curative therapy. Long-term disease-free survival rates of 50 to 60 percent or better can now be achieved routinely in patients with acute nonlymphocytic leukemia in first remission as well as in patients with CML in the chronic or early accelerated phase. Although not as striking, long-term survival can be achieved in patients with ALL or patients who have failed chemotherapy. Broader application of marrow grafting in the treatment of nonmalignant disease, such as AP, genetic disorders of hematopoie-sis, and immunodeficiency syndromes including AIDS, may become a reality.

Although survival after bone marrow transplantation is encouraging, the progressive development of pulmonary complications has become one of the most important factors limiting the overall success of marrow grafting. Nonbacterial interstitial pneumonia is a major complication of allogeneic bone marrow transplantation occurring in 30 to 40 percent of all patients and has a 60 percent mortality. Although most pulmonary complications occur within the first 100 days following marrow grafting, late pulmonary complications occur.* Late pulmonary complications include infectious bronchopneumonia, progressive interstitial pneumonitis, and the development of chronic obstructive airway disease.- Pulmonary function changes following bone marrow transplantation have revealed both restrictive and obstructive ventilatory defects.* In order to describe pulmonary functional changes following bone marrow transplantation and to determine clinical or demographic factors which might predict the development of pulmonary function abnormalities, we prospectively followed a well characterized cohort of patients posttransplantation for changes in pulmonary function. Factors influencing longitudinal changes in pulmonary function have been analyzed. mycanadianfamilypharmacy.net

Materials and Methods
Patient Population

Beginning in January of 1983, patients undergoing bone marrow transplantation at the Johns Hopkins Hospital received complete pulmonary function tests prior to marrow grafting. All patients were requested to return six months, 12 months, and annually thereafter for follow-up testing. Transplant diagnoses were limited to ALL, AML, AP and CML for the purpose of this study. All patients more than 18 years old and in continuous hematologic remission with a minimum of six months’ follow up are included in the present report. Forty patients who survived for at least six months were followed up elsewhere and are not included in the present report.


Category: Bone Marrow Transplantation

Tags: bone marrow transplantation, obstructive airway, Pulmonary function