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The impact of pulmonary function in patients undergoing autologous stem cell transplantation.

ABSTRACT: High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is an established therapy for patients with hematological malignancies. The age of patients undergoing auto-HSCT, and therefore the co-morbidities, has increased during the last decades. However, the assessment of organ dysfunction prior auto-HSCT has not been well undertaken. Therefore, we analyzed retrospectively the association of clinical factors, lung and cardiac function with outcome and complications after conditioning with BEAM (BCNU/carmustin, etoposide, cytarabine, melphalan) and high-dose melphalan of patients undergoing auto-HSCT. In this study, we included 629 patients treated with auto-HSCT (334 conditioned with BEAM and 295 with high-dose melphalan) at our institution between 2007 and 2017. The median follow-up for patients conditioned with BEAM was 52 months (range:0.2-152) and with high-dose melphalan 50 months (range:0.5-149). In the multivariate analysis, we identified progressive disease, CO-diffusion capacity corrected for hemoglobin (DLCOcSB)<60% of predicted, Karnofsky performance status (KPS)≤80%, HCT-CI score≥4 and age>70 years to be associated with decreased overall survival (OS) in patients treated with BEAM. Similarly, DLCOcSB<60% of predicted, HCT-CI score ≥4 and age>60 years were identified in patients treated with high-dose melphalan. Abnormalities in DLCOcSB<60% of predicted were associated with chemotherapy with lung toxic substances, mediastinal radiotherapy, KPS≤80%, current/previous smoking and treatment at the intensive care unit. Patients with decreased DLCOcSB<60% of predicted had more frequently non-relapse mortality, including pulmonary cause of death. In summary, we have identified DLCOcSB<60% of predicted as an independent risk factor associated with decreased OS in patients conditioned with BEAM and high-dose melphalan prior auto-HSCT.

SUBMITTER: Duque-Afonso J

PROVIDER: S-EPMC8579263 | biostudies-literature |

REPOSITORIES: biostudies-literature

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The impact of pulmonary function in patients undergoing autologous stem cell transplantation.

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