ABNORMALITIES OF PULMONARY-FUNCTION TESTS AFTER MARROW TRANSPLANTATION PREDICT NONRELAPSE MORTALITY

To determine whether pulmonary function test (PFT) results after marro w transplantation were predictive of nonrelapse mortality, a review wa s made of prospective, nonrandomized PFT results for association with nonrelapse mortality by log-rank test and Cox proportional hazards mod eling. The setting was a tertiary referral center. The patients were a ll marrow recipients who performed PFT between Days 60 and 120 after m arrow transplantation between July 1, 1983 and December 31, 1990 (n = 906). At 3 mo after transplantation, the mean values for total lung ca pacity (TLC) and diffusing capacity decreased, and restrictive ventila tory defects (TLC < 80% of predicted) were noted in 34% of the cohort Airflow rates (FEV(1)/FVC) were unchanged. A restrictive lung defect a t 3 mo after transplant or a significant decline (greater than or equa l to 15%) in TLC from baseline despite remaining within the normal ran ge was associated with a twofold increased risk of nonrelapse mortalit y. Neither airflow obstruction nor impairment in diffusing capacity wa s associated with an increased risk, Abnormalities of the TLC at 3 mo after transplant were associated with death with respiratory failure, but not with an increased risk of chronic graft-versus-host disease (G VHD). There is an increase in the nonrelapse mortality rate associated with either the presence of a restrictive defect 3 mo after marrow tr ansplantation or a significant decline in lung volume compared with ba seline. This effect is most pronounced more than 1 yr after marrow tra nsplant and appears to be a result of an increase in the rate of death with respiratory failure, not chronic GVHD. These results suggest tha t routine evaluation of lung function after marrow transplantation is warranted.