Pulmonary function testing prior to reduced intensity conditioning allogeneic stem cell transplantation in an unselected patient cohort predicts posttransplantation pulmonary complications and outcome

Piñana, José Luís; Martino, Rodrigo; Barba, Pere; Bellido-Casado, Jesús; Valcárcel, David; Sureda, Anna; Briones, Javier; Brunet, Salut; Rodríguez-Arias, J.M.; Casán, Pere; Sierra, Jorge

doi:10.1002/ajh.22183

Cited by 25 publications

(29 citation statements)

References 43 publications

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“…The present study confirmed that pulmonary function prior to allo‐HCT is a valuable predictor of patient mortality following allo‐HCT, which is consistent with previous reports . Notably, the small airway disease parameter

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50/

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25 is the strongest predictor of survival; it has a much higher predictive value than %FEV1.0 and FEV 1.0/FVC, which mainly reflect central airway obstruction.…”

Section: Discussionsupporting

confidence: 92%

“…Some investigators have demonstrated that lung function evaluated prior to allogeneic hematopoietic cell transplantation (allo‐HCT) is useful to identify patients at risk for pulmonary complications or death . However, the proportion of patients eligible for allo‐HCT who show significant abnormalities in the pulmonary function test (PFT) – specifically, percent predicted forced expiratory volume in 1 s (%FEV1.0) and percent predicted vital capacity (%VC) – before allo‐HCT is low.…”

Section: Introductionmentioning

confidence: 99%

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Lung function score including a parameter of small airway disease as a highly predictive indicator of survival after allogeneic hematopoietic cell transplantation

et al. 2016

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SUMMARYSome studies on the predictive value of determining pulmonary function prior to allogeneic hematopoietic cell transplantation (allo-HCT) have shown a significant association between pulmonary function test (PFT) parameters and pulmonary complications, and mortality. However, the percentage of patients showing abnormalities in pretransplant PFT parameters is low. We comprehensively evaluated the effect of pretransplant PFT parameters, including a marker of small airway disease (ratio of the airflow rate of 50% vital capacity to the airflow rate of 25% vital capacity ( _ V50/ _ V25), on outcomes in 206 evaluable patients who underwent allo-HCT at our institute. Notable among the significant parameters in a univariable analysis, _ V50/ _ V25 was the most powerful indicator of survival following allo-HCT (delta-Akaike information criterion [ΔAIC] = 12.47, Δv 2 = 14.47; P = 0.0001). Additionally, a pretransplant lung function score (pLFS) established by applying three parameters with superior predictive values including _ V50/ _ V25 represented a better discriminating variable for the prediction of survival. Our data demonstrate that a pLFS incorporating a parameter of small airway disease, rather than the parameters of central airway obstruction, may be useful for predicting patient survival following allo-HCT. Transplant International 2016; 29: 707-714 Key words allogeneic hematopoietic cell transplantation, lung function score, prognostic value for survival, small airway disease, _ V50/ _ V25

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\overset{V}{true}

50/

\overset{V}{true}

25 is the strongest predictor of survival; it has a much higher predictive value than %FEV1.0 and FEV 1.0/FVC, which mainly reflect central airway obstruction.…”

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Lung function score including a parameter of small airway disease as a highly predictive indicator of survival after allogeneic hematopoietic cell transplantation

et al. 2016

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“…[88][89][90][91] For this patient, we would initiate comprehensive pulmonary function evaluation as results of pulmonary function tests are predictive for long-term outcome of allo-HCT. 92,93 If the patient has a comorbidity score of 3 or greater, and this is consistent with the bedside clinical assessment, we would initiate induction therapy with hypomethylating agents. We would not ordinarily proceed with allogeneic transplantation in this setting.…”

Section: Questionsmentioning

confidence: 82%

How I treat acute myeloid leukemia presenting with preexisting comorbidities

Ofran

Tallman

Rowe

2016

Blood

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Acute myeloid leukemia (AML) is a devastating disease with an incidence that progressively increases with advancing age. Currently, only ∼40% of younger and 10% of older adults are long-term survivors. If untreated, the overall prognosis of AML remains dismal. Initiation of therapy at diagnosis is usually urgent. Barriers to successful therapy for AML are the attendant toxicities directly related to chemotherapy or those associated with inevitable aplasia. Organ dysfunction often further complicates such toxicities and may even be prohibitive. There are few guidelines to manage such patients and the fear of crossing the medico-legal abyss may dominate. Such clinical scenarios provide particular challenges and require experience for optimal management. Herein, we discuss select examples of common pretreatment comorbidities, including cardiomyopathy, ischemic heart disease; chronic renal failure, with and without dialysis; hepatitis and cirrhosis; chronic pulmonary insufficiency; and cerebral vascular disease. These comorbidities usually render patients ineligible for clinical trials and enormous uncertainty regarding management reigns, often to the point of withholding definitive therapy. The scenarios described herein emphasize that with appropriate subspecialty support, many AML patients with comorbidities can undergo therapy with curative intent and achieve successful long-term outcome.

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“…Previous studies have reported markedly impaired pulmonary function after HSCT with frequencies varying from 24% up to 83% with abnormal baseline spirometry predicting post‐HSCT abnormality. Most studies documented mainly restrictive dysfunction in HSCT patients as observed in our patient population.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary function following allogeneic stem cell transplantation in childhood: A retrospective cohort study of 51 patients

Madanat‐Harjuoja

Valjento

Vettenranta

et al. 2014

Pediatric Transplantation

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HSCT is associated with a high risk of late morbidity. The aim of this study was to evaluate the frequency, time frame, risk factors, and possible etiology of pulmonary dysfunction following allogeneic HSCT in childhood. We evaluated the pulmonary function of 51 HSCT patients (>6 yr), by including FVC and FEV1 values prior to (baseline) and annually up to five yr after HSCT. A Cox proportional hazards model was used to analyze the risk factors for a pulmonary event. Over half (59%) of the patients developed pulmonary dysfunction, mainly consisting of restrictive abnormalities. Acute GvHD (HR 4.31, 95% CI 1.47-12.63), chronic GvHD (HR 10.20, 95% CI 2.42-43.03), and an abnormal baseline pulmonary function (HR 4.82, 95% CI 1.02-22.84) were associated with post-transplant dysfunction. FEV1 (p < 0.001) and FVC (p < 0.001) declined significantly by 12 months after HSCT and both remained below the pre-HSCT level at up to four yr post-transplantation. HSCT in childhood is associated with early and persistent restrictive impairment of pulmonary function. Patients with extensive chronic GvHD are particularly vulnerable to severe pulmonary dysfunction. Scheduled pulmonary function testing is warranted as part of the follow-up of survivors of HSCT in childhood.

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Pulmonary function testing prior to reduced intensity conditioning allogeneic stem cell transplantation in an unselected patient cohort predicts posttransplantation pulmonary complications and outcome

Cited by 25 publications

References 43 publications

Lung function score including a parameter of small airway disease as a highly predictive indicator of survival after allogeneic hematopoietic cell transplantation

Lung function score including a parameter of small airway disease as a highly predictive indicator of survival after allogeneic hematopoietic cell transplantation

How I treat acute myeloid leukemia presenting with preexisting comorbidities

Pulmonary function following allogeneic stem cell transplantation in childhood: A retrospective cohort study of 51 patients

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