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Rationale It is unknown if diminished pulmonary function early after allogeneic hematopoietic transplant is associated with poor long-term outcomes. Objective To determine if posttransplant lung function is associated with 5-year non-relapse mortality and the development chronic graft-versus-host disease Methods Retrospective analysis of 2158 patients who had routine pulmonary function testing 60–120 days after transplant between 1992 and 2004. Cox regression was used to assess the hazard ratio for 5-year non-relapse mortality. A second analysis assessed the hazard ratio for the development of chronic graft-versus-host disease. Measurements Lung function score was the primary exposure and was calculated according to FEV1 and DLCO. Individual pulmonary function parameters were secondary exposures. The primary outcomes were 5-year non-relapse mortality and the development of chronic graft-versus-host disease. Main Results Most patients had normal lung function following transplant. A higher lung function score, signifying greater impairment, was associated with an increased risk of mortality [category 1 HR 1.47 (1.17–1.85); category 2 HR 3.38 (2.53–4.53); category 3 HR 7.80 (4.15–14.68)]. A similar association was observed for all individual pulmonary function parameters. Low FEV1 was associated with the subsequent development of chronic graft-versus-host disease [FEV1 70–79% HR 1.26 (1.01–1.57); 60–69% HR 1.48 (1.10–2.01); < 60% HR 2.02 (1.34–3.05)]. Models using either lung function score or individual pulmonary function parameters performed about equally well as judged by the c-statistic. Conclusions Impaired lung function at day 80 posttransplant was associated with a higher risk of non-relapse mortality. A low FEV1 following transplant was associated with developing chronic graft-versus-host disease within one year.

We conducted a 15-year retrospective cohort study to determine the prevalence of restrictive lung disease prior to allogeneic hematopoietic cell transplant (HCT), and to assess whether this was a risk factor for poor outcomes. 2545 patients were eligible for the analysis. Restrictive lung disease was defined as a total lung capacity (TLC) <80% of predicted normal. Chest x-rays and /or computed tomography scans were reviewed for all restricted patients to determine whether lung parenchymal abnormalities were unlikely or highly likely to cause restriction. Multivariate Cox-proportional hazard and sensitivity analyses were performed to assess the relationship between restriction and early respiratory failure and nonrelapse mortality. Restrictive lung disease was present in 194 subjects (7.6%) prior to transplantation. Among these cases, radiographically apparent abnormalities were unlikely to be the cause of the restriction in 149 (77%) subjects. In unadjusted and adjusted analyses, the presence of pulmonary restriction was significantly associated with a 2-fold increase in risk for early respiratory failure and nonrelapse mortality, suggesting that these outcomes occurring in the absence of radiographically apparent abnormalities may be related to respiratory muscle weakness. These findings suggest that pulmonary restriction should be considered as a risk factor for poor outcomes after transplant.

We found a high prevalence of self-reported asthma and high morbidity related to asthma symptoms in the previous 12 months among the study cohort. Symptoms were poorly controlled due to limited availability of medication and access to medical services.