PMID- 24548876 OWN - NLM STAT- MEDLINE DCOM- 20150409 LR - 20170930 IS - 1523-6536 (Electronic) IS - 1083-8791 (Linking) VI - 20 IP - 6 DP - 2014 Jun TI - Screening with spirometry is a useful predictor of later development of noninfectious pulmonary syndromes in patients undergoing allogeneic stem cell transplantation. PG - 781-6 LID - S1083-8791(14)00098-6 [pii] LID - 10.1016/j.bbmt.2014.02.011 [doi] AB - Noninfectious pulmonary syndromes (NIPS) frequently complicate allogeneic stem cell transplantation (allo-SCT). The most common and serious is the bronchiolitis obliterans syndrome, characterized by irreversible fixed airflow obstruction, impaired quality of life, and a high mortality. Treatment for established symptomatic disease is relatively ineffective. We therefore sought to identify potential predictive factors for development of NIPS, which may identify patients at risk in whom earlier intervention may be of benefit. Spirometry and diffusing capacity for carbon monoxide were performed before allo-SCT, day 100, and 1 year after allo-SCT. We retrospectively analyzed spirometry in consecutive patients having allo-SCT from 2004 to 2010, along with computed tomography and bronchoalveolar lavage results to identify cases of NIPS. Cases of bronchiolitis obliterans syndrome were defined as per current National Institutes of Health consensus guidelines. Spirometry results and baseline variables were compared between patients with and without NIPS to identify early predictors and risk factors for NIPS. Of 235 assessable patients, 23 (9.8%) developed NIPS. Median time of onset was day 367 (interquartile range [IQR], 144 to 544 days). Changes in forced expiratory volume in 1 second (DeltaFEV1.0) was the best predictor of later NIPS development. Median DeltaFEV1.0 from pretransplant to day 100 in patients later developing NIPS was -12% (IQR, -25% to -1%) versus -1% (IQR, -7% to +6%) in unaffected patients, P = .002. From pretransplant to 1 year, DeltaFEV1.0 was -19% (IQR, -37% to -6%) versus -3% (IQR, -10% to +4%) in patients later developing NIPS and unaffected patients, respectively, P < .001. Busulfan-based, but not total body irradiation-based, conditioning increased the risk of NIPS (hazard ratio, 9.4 [3.4 to 23.9], P < .001). No cases of NIPS were seen in the 53 patients who received in vivo T cell depletion with antithymocyte globulin (ATG, Genzyme Transplant, Cambridge, MA) (P < .0001). NIPS were associated with high transplant-related mortality relative to unaffected patients (hazard ratio, 6.6 [2.5 to 16.4], P < .001). Spirometry is a potentially useful screening test for identification of presymptomatic NIPS. We recommend 3-monthly spirometry surveillance for up to 2 years post-transplant. Our findings require prospective validation to identify patients in whom earlier intervention may potentially modify the natural history of this disease. CI - Copyright (c) 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved. FAU - Thompson, Philip A AU - Thompson PA AD - Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia. FAU - Lim, Andrew AU - Lim A AD - Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia. FAU - Panek-Hudson, Yvonne AU - Panek-Hudson Y AD - Melbourne EpiCentre, The Royal Melbourne Hospital, Melbourne, Australia. FAU - Tacey, Mark AU - Tacey M AD - Peter MacCallum Cancer Centre, East Melbourne, Australia. FAU - Hijazi, Ramzi AU - Hijazi R AD - Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia; Peter MacCallum Cancer Centre, East Melbourne, Australia. FAU - Ng, Ashley P AU - Ng AP AD - Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia. FAU - Szer, Jeff AU - Szer J AD - Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia. FAU - Ritchie, David AU - Ritchie D AD - Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia. FAU - Bajel, Ashish AU - Bajel A AD - Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: Ashish.bajel@mh.org.au. LA - eng PT - Journal Article DEP - 20140216 PL - United States TA - Biol Blood Marrow Transplant JT - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JID - 9600628 SB - IM MH - Adolescent MH - Adult MH - Female MH - Hematopoietic Stem Cell Transplantation/adverse effects/*methods MH - Humans MH - Lung/*pathology MH - Lung Diseases/*diagnosis/etiology MH - Male MH - Middle Aged MH - Spirometry MH - Syndrome MH - Transplantation Conditioning/adverse effects/methods MH - Transplantation, Homologous MH - Young Adult OTO - NOTNLM OT - Allogeneic OT - GVHD OT - Pulmonary OT - Screening OT - Spirometry OT - Transplant EDAT- 2014/02/20 06:00 MHDA- 2015/04/10 06:00 CRDT- 2014/02/20 06:00 PHST- 2013/09/23 00:00 [received] PHST- 2014/02/12 00:00 [accepted] PHST- 2014/02/20 06:00 [entrez] PHST- 2014/02/20 06:00 [pubmed] PHST- 2015/04/10 06:00 [medline] AID - S1083-8791(14)00098-6 [pii] AID - 10.1016/j.bbmt.2014.02.011 [doi] PST - ppublish SO - Biol Blood Marrow Transplant. 2014 Jun;20(6):781-6. doi: 10.1016/j.bbmt.2014.02.011. Epub 2014 Feb 16.