Implications of early airflow decline after myeloablative allogeneic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 33; no. 7; pp. 759 - 764
• Main Authors: CHIEN, J. W, MARTIN, P. J, FLOWERS, M. E, NICHOLS, W. G, CLARK, J. G
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.04.2004
• Subjects: Adolescent; Adult; Aged; Air flow; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Child, Preschool; Chronic obstructive pulmonary disease, asthma; Cohort Studies; Confidence intervals; Female; Health aspects; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic Stem Cell Transplantation - mortality; Hematopoietic stem cells; Humans; Male; Measurement; Medical sciences; Methods; Middle Aged; Mortality; Myeloablative Agonists - adverse effects; Myeloablative Agonists - therapeutic use; Patients; Physiological aspects; Pneumology; Pulmonary Disease, Chronic Obstructive - etiology; Pulmonary Ventilation; Respiratory Function Tests; Retrospective Studies; Risk; Stem cell transplantation; Stem cells; Survival Analysis; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods; Transplantation Conditioning - mortality; Transplantation, Homologous; Transplants & implants; United States; Hematology; Respiratory disease; Stem cell; Hematopoietic cell; Homograft; Bronchus disease; Graft; Myelosuppression; Bronchiolitis obliterans; airflow obstruction; Obstruction; hematopoietic stem cell transplant
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1704422

The clinical significance of early airflow decline after myeloablative allogeneic hematopoietic SCT is uncertain. We performed a retrospective cohort analysis to determine if airflow decline by day 100 is associated with later development of transplant-related airflow obstruction (AFO) and increased mortality risk. Overall, 750 (40%) patients had airflow decline by day 100. Development of airflow decline by day 100 was associated with an increased risk for AFO at 1 year (relative risk 2.6, 95% confidence interval 2.1-3.1) but not with an increase in mortality risk (hazard ratio (HR) 0.86, P=0.05). However, patients with the fastest rate of decline between day 100 and 1 year (12.5% per year +/-24) had the highest mortality risk (HR 3.2, P<0.001). In conclusion, airflow measurements made on day 100 do not predict the rate of airflow decline between day 100 and 1 year, and therefore are not useful as a single measurement for determining mortality risk associated with development of AFO. Closer monitoring of the rate of airflow decline during the first year may facilitate the timely detection and treatment of early airflow decline and prevent the development of fixed AFO and increased mortality risk after hematopoietic stem cell transplant.