Risk Factors for Airflow Obstruction in Recipients of Bone Marrow Transplants

作者：Joan G. Clark, DAVID A. SCHWARTZ, NANCY FLOURNOY, KEITH M. SULLIVAN, STEPHEN W. CRAWFORD, E. DONNALL THOMAS · 发表于：Annals of Internal Medicine · 年份：1987 · DOI：10.7326/0003-4819-107-5-648 · 被引用次数：186 · 研究领域：Hematopoietic Stem Cell Transplantation、Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis、Transplantation: Methods and Outcomes

Obstructive lung disease is a complication of bone marrow transplantation. 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 less than 0.0001), male gender (p = 0.02), cigarette smoking (p = 0.01), lower FEV1/FVC before transplantation (p less than 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.