DECREASED LUNG-FUNCTION IN ONE-YEAR SURVIVORS OF ALLOGENEIC BONE-MARROW TRANSPLANTATION CONDITIONED WITH HIGH-DOSE BUSULFAN AND CYCLOPHOSPHAMIDE

Conditioning with busulphan (BU) and cyclophosphamide (CY) prior to al logeneic bone marrow transplantation (BMT) is an alternative to regime ns that include total body irradiation (TBI), The aim of the study was to assess the occurrence and degree of lung function impairment after this treatment. Prospectively, 43 consecutive patients, aged 17-51 (m edian 31) yrs, were examined by lung function measurements and clinica l and radiographic evaluation, prior to BMT and at 3 month intervals u p to 1 yr after BMT. All patients had normal chest radiographs before BMT and at the 12 month follow-up, Mean baseline values were above 100 % of predicted normal for lung volumes and above 90% for gas transfer, Excluded from the lung function follow-up analyses were nine patients who had suffered infectious pneumonia and/or developed obliterative b ronchiolitis. For the remaining patients (n=34), mean alveolar volume (VA), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) had dropped by nearly 10% compared with baseline 3 month s after BMT, but were restored within 1 yr, FEV1/FVCx100 (FEV1%) was i ncreased, reflecting the restrictive pattern, Hb-adjusted transfer fac tor of the lungs for carbon monoxide (TL,CO) had dropped by 20% after 3 months, and remained reduced by 15% after 1 year, Prior to BMT the s mokers had significantly lower TL,Co than the nonsmokers, and after BM T the difference was accentuated, Reductions in lung function were ind ependent of sex, age and type of haematological disorder. We conclude that BMT with BU/CY is associated with transient declines in lung volu mes and a persistent reduction in gas transfer 1 yr after therapy, The decline in gas transfer is especially marked in smokers.