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Scheidl, S; Zinke-Cerwenka, W; Flick, H; Gaal, S; Avian, A; Greinix, H; Olschewski, H.
Whole body lung function test-derived outcome predictors in allogenic stem cell transplantation.
Biol Blood Marrow Transplant. 2018;
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Autor/innen der Med Uni Graz:
Avian Alexander
Flick Holger
Greinix Hildegard
Olschewski Horst
Scheidl Stefan
Zinke-Cerwenka Wilma
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Abstract:
Despite clinical advances, late onset pulmonary complications in adult recipients of allogenic stem cell transplantation are a major cause of morbidity and mortality. Reported incidence and risk factors in the literature vary broadly and are partly contradictory. Identification of pre-transplant factors associated with major complications would be helpful to define individual treatment strategies and early initiation of preventive measures. To evaluate incidence and risk factors of late-onset non-infectious pulmonary complications, with special regards to small airways disease (SAD) and bronchiolitis obliterans syndrome (BOS), indicating Graft versus Host Disease (GvHD), following myeloablative vs. non-myeloablative allogenic stem cell transplantation. We reviewed the clinical records and assessed the course of lung function and pulmonary complications in adults who underwent allogenic stem cell transplantation for hematological malignancies between 1999 and 2015 using non-myeloablative (n = 179) or myeloablative (n = 130) conditioning at the Division of Hematology of the Medical University of Graz. All patients underwent body plethysmography pulmonary function test (PFT), diffusion capacity for carbon monoxide (DLCO), and arterial blood gas analysis before and repeatedly after transplant. Small airways disease (SAD) was defined as maximal expiratory flow at 50% (MEF50) and 25% (MEF25) of forced vital capacity < 70% predicted. Ventilatory disorders and gas transfer abnormalities were common before and after allogenic stem cell transplantation, independent of conditioning regimen. SAD was common in the non-myeloablative and myeloablative group with 34% and 29%. The 100-days post-transplant mortalitiy was significantly associated with reduced pre-transplant total lung capacity (TLC) < 80%. Mortality after 100 days post-transplant was significantly associated with pre-transplant SAD and a pre-transplant smoking history. In this subset, a smoking history was independently associated with increased mortality with a five-year mortality of 45% compared to 26% in never smokers. Pre-transplant SAD was not predictive for the later development of bronchiolitis obliterans syndrome (BOS). Smoking history, pre-transplant restrictive PFT and pre-existing SAD are important risk factors for death following allogenic stem cell transplantation. However, pre-transplant SAD is not a predictor of long-term complications, including BOS. Copyright © 2018. Published by Elsevier Inc.

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