454 Decreased Pulmonary Function in Asymptomatic Long Term Survivors After Busulfan-Based Myeloablative Allogeneic Hematopoietic Stem Cell Transplant

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Annie Oh, MD , Section of Hematology/Oncology, University of Illinois Hospital & Health Sciences System, Chicago, IL
Pritesh Patel, MB, ChB , Section of Hematology/Oncology, University of Illinois Hospital & Health Sciences System, Chicago, IL
Santosh Saraf, M.D. , Section of Hematology/Oncology, University of Illinois Hospital & Health Sciences System, Chicago, IL
Karen Sweiss, PharmD, BCOP , Pharmacy, University of Illinois Hospital & Health Sciences System, Chicago, IL
David Peace, MD , Section of Hematology/Oncology, University of Illinois Hospital & Health Sciences System, Chicago, IL
John Quigley, MD , Section of Hematology/Oncology, University of Illinois Hospital & Health Sciences System, Chicago, IL
Nadim Mahmud, MD, PhD , Section of Hematology/Oncology, University of Illinois Hospital & Health Sciences System, Chicago, IL
Steven Dudek, MD , Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Hospital & Health Sciences System, Chicago, IL
Damiano Rondelli, MD , Section of Hematology/Oncology, University of Illinois Hospital & Health Sciences System, Chicago, IL

Pulmonary function post allogeneic hematopoietic stem cell transplant (HSCT) can be impaired by previous exposure to chemotherapy, infection, or graft versus host disease (GVHD).  In this retrospective study, we analyzed 21 patients with hematologic malignancies who are 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 busulfan-based regimen. Of 21 patients, 7 are of Caucasian and 14 non-Caucasian ethnicity. All patients had routine pulmonary function tests (PFTs) repeated within two years from transplant and none had underlying lung disease.  To eliminate inter-lab variability, all PFTs were performed in the same laboratory.  Survival rate at the time of analysis was 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. FEV1 and FEV1/FVC were significantly decreased (108 vs 92, p=0.04 and 86 vs 80%, p=0.04, respectively), with no difference between Caucasian and non-Caucasians.  Overall, median values of corrected DLCO and TLC prior to and after transplant were only slightly reduced. However, in non-Caucasian patients a significant reduction of DLCO was observed (93%±31 vs 73%±11, p=0.05).

We analyzed intra-patient changes in DLCO and FEV1 values and no correlation was found between these parameters and the development of chronic GVHD. 

This study shows an overall decrease in pulmonary function in patients without apparent lung disease following a myeloablative busulfan-based HSCT.  However, a higher risk of a reduced DLCO was noted only among non-Caucasian patients. At this time it is not known if this observation is due to genetic, biologic or environmental causes.

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