Arterial blood oxygenation, maximum exercise capacity and oxygen transport in patients before and after autologous peripheral blood progenitor cell transplantation

Abstract

Summary:Several studies have reported a reduced pulmonary diffusion capacity for carbon monoxide after total body irradiation (TBI) and/or high-dose chemotherapy (HDCT) and autologous peripheral blood progenitor transplantation (APBPC). The present study describes the oxygenation of arterial plasma (paO 2 ), the maximum exercise capacity (Wmax) and maximum oxygen transport (VO 2 max) before and after such treatment. Pulmonary gas exchange and paO 2 were measured in 15 patients at maximum dynamic bicycle exercise, performed before and at 8 ؎ 0.9 (s.e.m.) months after TBI/HDCT (n = 12) and HDCT (n = 3) followed by APBPC. Wmax was 169 ؎ 14 and 157 ؎ 15 watts (P Ͼ 0.05) before and after therapy, respectively. VO 2 max, 1.8 ؎ 0.1 l/min before treatment, fell to 1.6 ؎ 0.1 l/min (P Ͻ 0.05) after therapy. The maximum exercise paO 2 was 13.2 ؎ 0.4 kPa before and 13.6 ؎ 0.4 kPa (P Ͼ 0.05) after the treatment period. The findings indicate no significant reduction of Wmax or pulmonary diffusion capacity for O 2 after TBI/HDCT and APBPC while VO 2 max fell modestly by approximately 11%. The study was restricted to patients who remained in remission. Keywords: arterial plasma pO 2 ; hematological malignancies; hematopoietic stem cell transplantation; maximum oxygen uptake; pulmonary diffusion capacity Since the introduction of allogeneic bone marrow transplantation (BMT) for the treatment of hematological and other disorders, pulmonary toxicity has been of particular concern and has significantly contributed to both morbidity and mortality (10-40% of toxicity-related deaths). 1 Major factors, thought to be associated with pulmonary toxicity/dysfunction and delayed/incomplete recovery of pulmonary function tests in the allogeneic BMT setting are total body irradiation (TBI), acute and chronic graft-versushost disease and post-transplant pulmonary infection. 2,3 The rapidly increasing number of patients undergoing high-dose treatment with autologous stem cell transplan- tation may present an increasing medical problem with regard to cardiopulmonary sequelae. Procedure-related morbidity and mortality for patients with hematological and solid tumors have been substantially reduced by new developments in stem cell processing, eg autologous peripheral blood progenitor transplantation (APBPC) and improved supportive care. Nevertheless, cardiopulmonary complications have remained a major threat. 4 With the introduction of non-TBI containing high-dose therapies and the omission or dose-reduction of BCNU, acute and long-term lung toxicity seem to have decreased. 5-7 However, published studies reveal considerable variations concerning patient populations, types of high-dose treatment and stem cell sources, post-transplantation treatments, and methods used for the evaluation of cardiopulmonary function. Several earlier studies have indicated that chemotherapy and TBI prior to bone marrow transplantation may lead to pulmonary dysfunction, including a reduced diffusion capacity for carbon monoxide (CO) within the first months after the the...