Abstract 1322

Background:

Pre-transplant work-up prior to an allogeneic stem cell transplant (allo-SCT) generally includes pulmonary functions tests (PFT) with assessment of FEV1 and DLco. It has been previously published that patients with a DLco or FEV1 less than 60% of predicted have higher non-relapse mortality (NRM) when undergoing a myeloablative allo-SCT. However, the PFT criteria for selecting candidates for a reduced intensity (RI) allogeneic transplant allo-SCT remains poorly investigated. We performed a retrospective analysis to assess the impact of low FEV1 or DLco on NRM and overall survival (OS) in patients undergoing a RI allo-SCT.

Methods:

All patients who underwent a RI allo-SCT for hematological malignancies at MD Anderson Cancer Center from Jan 2000 to April 2009 were included. Using Cox's proportional hazards regression, we compared the rate of NRM and OS between patients who had a pre-transplant FEV1 or DLco > 50% (control group) prior to a RI allo-SCT and those with FEV1 and DLco < 50% (study group). The cumulative incidence of NRM was estimated considering disease progression as a competing risk. Actuarial OS was estimated by the Kaplan-Meier method.

Results:

Patient characteristics are presented in Table 1. There were no statistically significant differences between the study and control groups except for age and sex. A significantly higher proportion of patients were > 50 years in the control group (65%) compared with the low PFT group (45%, P=0.02) and there were more males in the control group (P=.001). The median FEV1 and DLco in the study group was 55% (28-111) and 47% (33-98) of predicted, respectively. On univariate analysis abnormal PFTs did not impact OS at 30 months (HR 1.1, 95% CI 0.7–1.8, P=0.7) or NRM at 1 year (HR 1.3, (95% CI 0.6–2.7, P=0.4). Active disease at SCT, and a diagnosis of CLL, NHL or HL were associated with significantly worse OS and NRM, whereas age >50 years was only associated with worse OS. Low PFT had no significant impact on OS and NRM when evaluated separately in patients older or younger than 50 years old.

Conclusion:

Our experience suggests that a low (<50% of predicted) FEV1 or a DLco on pre-transplant evaluation does not adversely impact NRM and OS after RI allo-SCT. These findings need to be validated in a multivariate analysis.

Table 1:

Patient Characteristics

Low PFT (N, %)Control (N, %)p–value
Number of patients 33 774  
Follow–up (Median, range) months 33 (5–95) 28 (1–116)  
Age, Median, years (range) 48 (21–77) 55 (20–77) 0.06 
Sex, male 12 (36%) 497 (64%) 0.001 
Active disease at RI allo-SCT 24 (73%) 555 (72%) 0.9 
Donor:    
MRD 19 (58%) 332 (43%) 0.09 
MUD 13 (39%) 373 (48%)  
Other 1 (3%) 69 (9%)  
Cell Source:    
Peripheral blood 25 (76%) 505(65%) 0.2 
Bone marrow 8 (24%) 269 (35%)  
Diagnosis:    
AML/MDS/ALL/CML 15 (48%) 337 (43%) 0.7 
CLL/NHL/HL 12 (36%) 337 (43%)  
MM/AA/Other 5 (15%) 100 (13%)  
Low PFT (N, %)Control (N, %)p–value
Number of patients 33 774  
Follow–up (Median, range) months 33 (5–95) 28 (1–116)  
Age, Median, years (range) 48 (21–77) 55 (20–77) 0.06 
Sex, male 12 (36%) 497 (64%) 0.001 
Active disease at RI allo-SCT 24 (73%) 555 (72%) 0.9 
Donor:    
MRD 19 (58%) 332 (43%) 0.09 
MUD 13 (39%) 373 (48%)  
Other 1 (3%) 69 (9%)  
Cell Source:    
Peripheral blood 25 (76%) 505(65%) 0.2 
Bone marrow 8 (24%) 269 (35%)  
Diagnosis:    
AML/MDS/ALL/CML 15 (48%) 337 (43%) 0.7 
CLL/NHL/HL 12 (36%) 337 (43%)  
MM/AA/Other 5 (15%) 100 (13%)  
View Large
Table 2:

Cumulative incidence of Non-relapse mortality and ActuarialSurvival

Low PFTs (N=33)Control (N=774)p–value
% NRM    
3 months 12 (95% CI 5–30) 10 (95% CI 8–13) 0.8 
12 months 25 (95% CI 13–45) 21 (95% CI 18–25) 0.4 
% OS:    
3 months 88 (95% CI 71–95) 88 (95% CI 85–90) 0.9 
12 months 53 (95% CI 34–68) 62 (95% CI 58–65) 0.3 
Low PFTs (N=33)Control (N=774)p–value
% NRM    
3 months 12 (95% CI 5–30) 10 (95% CI 8–13) 0.8 
12 months 25 (95% CI 13–45) 21 (95% CI 18–25) 0.4 
% OS:    
3 months 88 (95% CI 71–95) 88 (95% CI 85–90) 0.9 
12 months 53 (95% CI 34–68) 62 (95% CI 58–65) 0.3 
View Large
Disclosures:

No relevant conflicts of interest to declare.

Topics:
carbon monoxide diffusing capacity test, forced expiratory volume function, pulmonary function tests, stem cells, transplantation, allopurinol, allogeneic stem cell transplant, disease progression, follow-up, hematologic neoplasms

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
Sign in via your Institution