JOAN G. CLARK, M.D.; DAVID A. SCHWARTZ, M.D., M.P.H.; NANCY FLOURNOY, Ph.D.; KEITH M. SULLIVAN, M.D.; STEPHEN W. CRAWFORD, M.D.; E. DONNALL THOMAS, M.D.
Obstructive lung disease is a complication of bone marrow transplantion. 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-nonidentical 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. Risk Factors for Airflow Obstruction in Recipients of Bone Marrow Transplants. Ann Intern Med. ;107:648–656. doi: 10.7326/0003-4819-107-5-648
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Published: Ann Intern Med. 1987;107(5):648-656.
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