Risk Factors for Airflow Obstruction in Recipients of Bone Marrow Transplants

Abstract

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.