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Risk Factors for Airflow Obstruction in Recipients of Bone Marrow Transplants

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.; and E. DONNALL THOMAS, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Joan G. Clark, M.D., Fred Hutchinson Cancer Research Center, 1124 Columbia Street; Seattle, WA 98104.


Seattle, Washington


©1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;107(5):648-656. doi:10.7326/0003-4819-107-5-648
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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.

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