Lung function prior to stem cell transplant as a predictor of infectious and pulmonary complications and survival in adults with haematologic malignancies

Introduction: autologous stem cell transplantation (ASCT) represents a standard of care for multiple myeloma patients eligible for high-dose therapy, for lymphoma patients undergoing second line treatments and in acute leukemia. Pulmonary and infective complications are a cause of morbidity and mortality after ASCT.While several reports focusing on allogenic transplantation exist,the relationship between pre-transplant pulmonary function tests(PFTs)and development of post-ASCT complications and mortality is unknown. Materials and Methods: complete PFTs were obtained in 67 patients candidate to ASCT for hematological malignancies.Complication rate and survival were obtained and correlations with PFTs assessed. Results: of the 67 transplanted patients(mean age 53.4,SD11.1),47(70%)were males;9(13.4%)had abnormal PFTs at baseline.Effects of ASCT were:partial response in 42(64.6%),complete remission in 17(26.2%),disease progression in 3(4.6%)and stable disease in 3(4.6%). Infective complications occurred in 40(59.7%)and respiratory complications in 9(13.4%).The overall survival rate was 71%(48/67-median follow up:25 months).Mean FEV1 percent of predicted pre ASCT resulted reduced(97%vs83%;p=0.05)in patients with post ASCT respiratory complications,while DLCO and KCO were lower(45.6vs59.0% of predicted;p=0.02)in patients who did not survive. Conclusions: abnormal pre ASCT FEV1 increased the risk of respiratory complications after ASCT,depressed DLCO and KCO the risk of death.These patients may benefit from modified transplant strategies to reduce morbidity and mortality.