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Pulmonary Rehabilitation |

Abnormal Pulmonary Function Testing Before Allogeneic Stem Cell Transplantation Predicts Mortality

Jessica Barks; Kyle Brownback
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Pulmonary-Critical Care, University of Kansas Medical Center, Kansas City, KS


Chest. 2014;146(4_MeetingAbstracts):815A. doi:10.1378/chest.1991238
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Abstract

SESSION TITLE: Physiology/PFTs/Rehabilitation

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 28, 2014 at 08:45 AM - 10:00 AM

PURPOSE: Evaluate allogeneic Stem Cell Transplant (SCT) affect on Pulmonary Function Test (PFT) and abnormal pre-transplant PFTs prediction on mortality after transplant.

METHODS: Retrospective chart review of patients who underwent allogeneic, matched sibling donor SCT from 1/28/2011 to 12/31/2012 at an academic medical center was performed. Pre-transplant PFTs and 12 months post-transplant PFTs were assessed. Abnormal PFTs were defined as those with a FEV1/VC ratio <0.7, FVC <80% predicted, or TLC <80% predicted. Death at censorship was evaluated. Chi-squared test was performed for categorical data. Fischer’s exact test was utilized to calculate the odds ratio of mortality.

RESULTS: 68 patients underwent allogeneic SCT during a 23-month period. Pre-transplant PFTs showed that 49 patients had normal PFTs, and 19 patients had abnormal PFTs. Of the abnormal PFTs, 8 were obstructed, 7 were restricted, and 1 was a nonspecific ventilatory defect. At 12 months post-transplant PFTs, there were 5 new obstructions, no new restrictions, and 2 new nonspecific ventilatory defects. 26 patients were deceased at censorship. The mortality rate of those with pre-transplant obstruction was 62.5% (5/8). Only 9 of 19 patients (47.4%) with abnormal pre-transplant PFTs survived to censorship, compared to 33 of the 49 patients (67.3%), with normal pre-transplant PFTs (p=0.16). The odds ratio of mortality in those with abnormal PFTs pre-transplantation was 2.29 (CI 0.78 to 6.75).

CONCLUSIONS: SCT can affect post-transplant PFTs, most commonly resulting in new obstruction in our study. Abnormal pre-transplant PFTs may carry an increased risk of mortality after transplant, though not statistically significant.

CLINICAL IMPLICATIONS: Careful consideration should be given to those patients whom have abnormal PFTs prior to SCT, as there is a potential trend towards increased mortality after transplantation compared to those with normal pre-transplant PFTs.

DISCLOSURE: The following authors have nothing to disclose: Jessica Barks, Kyle Brownback

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