Abstract
Abstract 4474
Pulmonary function post allogeneic hematopoietic stem cell transplant (HSCT) can be impaired by previous exposure to chemotherapy, infection, or underlying chronic graft versus host disease (cGVHD). In this retrospective study, we selected 21 long term transplant survivors with a median follow up of 48 months who had received a related (60%) or unrelated (40%) HSCT conditioned with a myeloablative busulfan-based regimen. All patients had routine pulmonary function tests (PFTs) repeated within two years from transplant and none had respiratory symptoms or a history of chronic lung infection at the time of analysis.
Median age was 45 years (range 18–54). Patients had a diagnosis of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) (52%), acute lymphoblastic leukemia (ALL) (14%), chronic myeloid leukemia (CML) (14%), non-Hodgkin lymphoma (NHL) (9%), or chronic lymphocytic leukemia (CLL) (2%). Survival rate at the time of analysis is 90%.
We initially compared single parameters of PFTs including corrected diffusion limiting capacity of oxygen (DLCO), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and total lung capacity (TLC) obtained before and after transplant. Post transplant, all PFT parameters showed some degree of reduction compared to pre-transplant values (Figure 1). FEV1 and FEV1/FVC were significantly decreased (108 vs 92,p=0.04 and 86 vs 80%, p=0.04, respectively). Median values of corrected DLCO prior to and after transplant were 83% (range 55–148) and 77%(range 44–146) (p=0.2), respectively.
In order to test whether patients with >10% reduction of PFTs had an increased rate of overall cGVHD, we analyzed intra-patient changes in DLCO and FEV1 values. We then divided patients into groups with extensive, limited, or no cGVHD. No correlation was found between the degree of cGVHD and FEV1 or DLCO values.
A decrease in pulmonary function was detected in patients who received a busulfan based myeloablative HSCT despite the absence of lung infection or pulmonary cGVHD. This finding, however, did not affect long term survival.
Disclosures:
No relevant conflicts of interest to declare.
Long-term outcome and prognostic factors of second allogeneic hematopoietic stem cell transplant for acute leukemia in patients with a median follow-up of ⩾10 years
