Risk factors for airflow obstruction in recipients of bone marrow transplants
Obstructive lung disease is a complication of bone marrow transplantation. To identify risk factors we analyzed pulmonary function tests of 281 adult patients 1 year after marrow transplantation. The forced expiratory volume at 1 second divided by the forced vital capacity (FEV1/FVC) was used to measure airflow rates. Factors associated with a lower year-1 FEV1/FVC (%) included increased age (p<0.0001), male gender (p=0.02), cigarette smoking (p=0.01), lower FEV1/FVC before transplantation (p<0.0001), HLA-nonincidental grafts (p=0.001), chronic graft-versus-host disease (p=0.0002), and immunosuppressive therapy with methotrexate (p=0.01). There was no significant association between the year-1 FEV1/FVC and underlying disease, dose of conditioning irradiation, or development of acute graft-versus-host disease. Linear multivariate regression analysis, after controlling for the FEV1/FVC before transplantation, shows both chronic graft-versus-host disease and administration of methotrexate independently associated with decrements in the year-1 FEV1/FVC. The combined occurrence of chronic graft-versus-host disease and methotrexate also was strongly associated with decreases in the year-1 FEV1/FVC, indicating an interaction of these risk factors.
Clark, JG; Schwartz, DA; Flournoy, N; Sullivan, KM; Crawford, SW; Thomas, ED
Annals of Internal Medicine
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