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• W2154968299 abstract "Background: The NIH recently published a consensus statement that recommends monitoring FEV1 and DLCO to evaluate changes in lung function after allogeneic hematopoietic cell transplantation (aHCT). Although this recommendation was based upon previous analysis of pre-transplant pulmonary function tests (PFT), their clinical validity and utility have not yet been examined. We conducted an analysis to determine whether FEV1 and DLCO are the most informative measurements for post-transplant lung function change by assessing their relationship with mortality after aHCT. Methods: We performed a retrospective review of 1929 patients who underwent aHCT from 1993–2002 and received PFTs within 60–100 days after transplant. Post-transplant FEV1, FVC, TLC, and DLCO were categorized as >/=80, 70–80, 60–70 and < 60% predicted. FEV1/FVC ratio was categorized as >/= 0.7 and < 0.7. Per NIH recommendations lung function score (LFS, range 2–12) was calculated using FEV1 and DLCO. LFS was then categorized from 0–3 (category O = LFS 2; category 1 = LFS 3–5; category 2 = LFS 6–9; category 3 = LFS 10–12). Results: Two year all cause mortality after aHCT was 32%. Univariate analysis showed a stepwise increase in mortality with each categorical decrease in FEV1, FVC, TLC, and DLCO. There was no significant relationship between FEV1/FVC ratio and mortality. Mortality increased with increasing LFS (category 1 hazard ratio [HR], 1.50; category 2 HR, 2.86; category 3 HR, 5.64; p < 0.001; c-statistic 0.6). The LFS appeared to have a stronger association with mortality than did any individual lung function parameter. However, the LFS was not uniformly distributed with a significantly lower number of patients in LFS categories 2 and 3 (mean LFS score 3.3). Summary: These results suggest that decreased lung function by day 100 following aHCT is a risk factor for mortality. An elevated LFS is associated with an increased risk of mortality. The LFS may serve as a mechanism to grade severity of decreased lung function in future clinical trials. However, the scoring system may need to be altered to improve discrimination as it is currently weighted towards patients with normal to near normal lung function. Abbreviations: FEV1=Forced expiratory volume in 1 sec, FVC=Forced vital capacity, TLC=Total lung capacity, DLCO=Diffusion capacity of carbon monoxide.Tabled 1Two year mortality as a function of post-transplant lung function parameters and lung function score categoriesLung function parametersDied (%)HR (95% CI)p-valueFEV1 (%) (n = 1929) >80388/1397 (28)Referent 70–80112/310 (36)1.39 (1.13–1.72)0.002 60–7066/144 (46)1.96 (1.51–2.55)<0.001 <6056/78 (72)3.84 (2.90–5.09)<0.001FVC (%) (n = 1929) >80429/1545 (28)Referent 70–80103/236 (44)1.81 (1.46–2.25)<0.001 60–7055/101 (54)2.44 (1.85–3.24)<0.001 <6035/47 (74)4.19 (2.97–5.92)<0.001TLC (%) (n = 1904) >80475/1644 (29)Referent 70–8086/187 (46)1.87 (1.49–2.36)<0.001 60–7033/56 (59)2.64 (1.85–3.76)<0.001 <6013/17 (76)4.35 (2.51–7.55)<0.001DLCO (%) (n = 1893) >80245/995 (25)Referent 70–80127/408 (31)1.28 (1.03–1.59)0.023 60–70142/311 (46)2.12 (1.72–2.60)<0.001 <6091/179 (51)2.50 (1.96–3.18)<0.001LFS category (n = 1893) 0 (LFS 2)205/849 (24)Referent 1 (LFS 3–5)291/851 (34)1.50 (1.25–1.79)<0.001 2 (LFS 6–9)96/178 (54)2.86 (2.25–3.65)<0.001 3 (LFS 10–12)13/15 (87)5.64 (3.22–9.88)<0.001Definition of abbreviations: CI = confidence interval; LFS = Lung function score. Data was not available for all lung function parameters for all patients. Open table in a new tab Definition of abbreviations: CI = confidence interval; LFS = Lung function score. Data was not available for all lung function parameters for all patients." @default.
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• W2154968299 date "2008-02-01" @default.
• W2154968299 modified "2023-10-03" @default.
• W2154968299 title "51: National Institute of Health's Recommendation for Assessing Lung Function After Allogeneic Hematopoietic Cell Transplantation Predicts Mortality Risk" @default.
• W2154968299 doi "https://doi.org/10.1016/j.bbmt.2007.12.059" @default.
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