CARDIOPULMONARY FUNCTION AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION -RESULTS AND PREDICTIVE VALUE FOR RESPIRATORY-FAILURE AND MORTALITY

Cardiopulmonary complications are a major cause of morbidity and morta lity in patients undergoing high-dose therapy with stem cell transplan t support, Since exercise tolerance testing (ETT) assesses the cardiop ulmonary reserve of an individual, we hypothesized that ETT performed prior to transplant would predict respiratory failure and mortality an d would be a superior predictor over resting cardiopulmonary function tests, We performed a retrospective study of 191 lymphoma patients who underwent ETT prior to transplant between 1 June 1990 and 31 Decemher 1992 and compared the results of ETT with resting pulmonary function tests (PFT) and resting cardiac ejection fraction (EF), ETT revealed t hat cardiac, pulmonary and combined cardiopulmonary limitation were ob served in 31, 20 and 16% of the patients, respectively, with a gas dif fusion-type limitation being the most common exercise limitation, Rest ing PFT were abnormal in 58% of patients with a diffusion defect being the most common abnormality, Low EF was observed in 6.8% of patients, Twelve patients eventually required mechanical ventilation post-trans plant with only the resting diffusion PFT predictive of this complicat ion, There were five early deaths that were attributable to respirator y failure and neither resting nor ETT studies were predictive of these deaths, ETT and EF performed prior to transplant in lymphoma patients undergoing autologous transplant do not predict for either respirator y failure or short-term mortality, Our findings may be due to the rath er low incidence of respiratory failure (6.3%) and low early mortality from cardiopulmonary complications (2.6%) seen in our patient populat ion.