Chronic GVHD and pretransplantation abnormalities in pulmonary function are the main determinants predicting worsening pulmonary function in long-term survivors after stem cell transplantation

Biol Blood Marrow Transplant. 2006 Dec;12(12):1261-9. doi: 10.1016/j.bbmt.2006.07.016.


Pulmonary function (PF) was studied in 69 consecutive patients with hematologic diseases, with a minimum 5-year (range, 5-13 years) follow-up after allogeneic stem cell transplantation from an HLA-matched sibling. Fifty-six patients (81%) received total body irradiation based myeloablative stem cell transplantation (MT) and 13 (19%) underwent nonmyeloablative stem cell transplantation (NST). Thirty-one patients (45%) developed a late decrease in PF from baseline, 25 with a restrictive and 6 with an obstructive pattern PF abnormality. Twelve patients (17%) were symptomatic, 8 with a severe restrictive PF defect, but none required supplemental oxygen. The incidence of developing a late PF abnormality was comparable in MT (24 of 56) and NST (5 of 13; P = .51). In multivariate analysis, chronic graft-versus-host disease (relative risk, 16) and pretransplantation diffusion capacity for carbon monoxide or forced expiratory volume in the first second <80% predicted were independently associated with a late decrease in PF from baseline (relative risk, 7). Our results indicate that late PF abnormality is common after MT and NST. Patients with a low pretransplantation diffusion capacity for carbon monoxide of or forced expiratory volume in the first second who developed chronic graft-versus-host disease were most severely affected. Longer follow-up is needed to determine whether PF will continue to decrease or reach a plateau and whether more patients with PF abnormality will eventually become symptomatic.

MeSH terms

  • Adolescent
  • Adult
  • Carbon Monoxide / pharmacokinetics
  • Child
  • Chronic Disease
  • Comorbidity
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Graft vs Host Disease / complications*
  • Hematologic Diseases / physiopathology
  • Hematologic Diseases / surgery
  • Hematologic Neoplasms / physiopathology
  • Hematologic Neoplasms / surgery*
  • Humans
  • Lung / physiopathology*
  • Lung Diseases / complications*
  • Lung Diseases / physiopathology
  • Male
  • Middle Aged
  • Peripheral Blood Stem Cell Transplantation* / adverse effects
  • Postoperative Complications / etiology*
  • Proportional Hazards Models
  • Pulmonary Diffusing Capacity
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / physiopathology
  • Survival Analysis
  • Transplantation Conditioning / adverse effects
  • Treatment Outcome
  • Whole-Body Irradiation / adverse effects


  • Carbon Monoxide