TY - JOUR
T1 - Repair of impaired pulmonary function is possible in very-long-term allogeneic stem cell transplantation survivors
AU - Jain, Natasha A.
AU - Pophali, Priyanka A.
AU - Klotz, Jeffrey K.
AU - Ito, Sawa
AU - Koklanaris, Eleftheria
AU - Chawla, Kamna
AU - Hourigan, Christopher S.
AU - Gormley, Nicole
AU - Savani, Bipin N.
AU - Barrett, Austin John
AU - Battiwalla, Minoo
N1 - Funding Information:
Financial disclosure: Supported by the intramural research program of the National Heart, Lung, and Blood Institute, National Institutes of Health .
PY - 2014/2
Y1 - 2014/2
N2 - Both early- and late-onset noninfectious pulmonary injury are important contributors to the nonrelapse mortality seen after allogeneic stem cell transplantation (allo-SCT), particularly in subjects conditioned with high-dose total body irradiation (TBI). To characterize the kinetics of recovery from pulmonary injury in long-term survivors, we collected data on 138 subjects who survived > 3 years (median survival, 10.2 years) after predominantly TBI-based allo-SCT from their HLA-matched siblings. Baseline pulmonary function tests served as the reference for subsequent measurements at 3, 5, 10, and 15 years for each survivor. The only parameter showing a clinically and statistically significant decline post-transplant was adjusted diffusion capacity of lung for carbon monoxide (DLCO), which reached a nadir at 5 years but surprisingly normalized at the 10-year mark. Multivariable modeling identified chronic graft-versus-host disease (P < .02) and abnormal baseline-adjusted DLCO (P < .03) as the only significant factors associated with the decline in adjusted DLCO at 5 years but excluded smoking, conditioning intensity, baseline C-reactive protein level, TBI dose to the lungs, disease, and demographic variables. In conclusion, pulmonary injury as monitored by the adjusted DLCO continues to deteriorate in the first 5 years after allo-SCT but recovers at 10 years.
AB - Both early- and late-onset noninfectious pulmonary injury are important contributors to the nonrelapse mortality seen after allogeneic stem cell transplantation (allo-SCT), particularly in subjects conditioned with high-dose total body irradiation (TBI). To characterize the kinetics of recovery from pulmonary injury in long-term survivors, we collected data on 138 subjects who survived > 3 years (median survival, 10.2 years) after predominantly TBI-based allo-SCT from their HLA-matched siblings. Baseline pulmonary function tests served as the reference for subsequent measurements at 3, 5, 10, and 15 years for each survivor. The only parameter showing a clinically and statistically significant decline post-transplant was adjusted diffusion capacity of lung for carbon monoxide (DLCO), which reached a nadir at 5 years but surprisingly normalized at the 10-year mark. Multivariable modeling identified chronic graft-versus-host disease (P < .02) and abnormal baseline-adjusted DLCO (P < .03) as the only significant factors associated with the decline in adjusted DLCO at 5 years but excluded smoking, conditioning intensity, baseline C-reactive protein level, TBI dose to the lungs, disease, and demographic variables. In conclusion, pulmonary injury as monitored by the adjusted DLCO continues to deteriorate in the first 5 years after allo-SCT but recovers at 10 years.
KW - Adjusted DLCO
KW - Allogeneic
KW - BMT
KW - DLCO
KW - HSCT
KW - Long-term survivor
KW - Lung shielding
KW - Pulmonary complications
KW - Pulmonary function
KW - Stem cell transplant
KW - Total body irradiation
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U2 - 10.1016/j.bbmt.2013.10.025
DO - 10.1016/j.bbmt.2013.10.025
M3 - Article
C2 - 24188917
AN - SCOPUS:84893140438
SN - 1083-8791
VL - 20
SP - 209
EP - 213
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 2
ER -