1. Department of Geriatrics Unit of Respiratory Pathophysiology
Lung function prior to stem cell transplant as a predictor of infectious and pulmonary complications and survival in adults with haematologic malignancies
Scarlata Simone, Annibali Ombretta, Santangelo Simona, Chiodi Francesca, Ferraro Silvia, Tirindelli Maria Cristina, Avvisati Giuseppe, Antonelli Incalzi Raffaele
Presenting Author: Simone Scarlata, MD
Department of Geriatrics Unit of Respiratory Pathophysiology
Area Ematologia Trapianto Cellule Staminali Medicina Trasfusionale e Terapia cellulare
Campus Bio Medico University and Teaching Hospital
Rome - Italy 1

2. BACKGROUND
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 (Cancer Invest 2002; 20:880-8.), the relationship between pre-transplant pulmonary function tests (PFTs) and development of post-ASCT complications and mortality is basically unknown.

3. BACKGROUND

4. BACKGROUND

5. BACKGROUND
Biol Blood Marrow Transplant Aug 7. pii: S (15)

6. AIMS OF THE STUDY
To evaluate the association between pulmonary function tests indexes obtained prior to autologus stem cell transplantation with:
pulmonary complications
infectious side effects
mortality.

7. 81 consecutive ASCT recipients
Study design
81 consecutive ASCT recipients
Spirometry
Lung volumes
DLCO
KCO
Blood gas analysis
Pre-transplant
PFT evaluation
ASCT
One –way analysis of variance
Differences in PFR mean values by survival and infectious occurrence rate
Kaplan-Meier curves and hazard models
Relationships between post-transplant survival and infective complication’s rate
Post-transplant evaluation

8. Results Age Years (mean; SD) 53.7 (10.3) Males (n°; %) 57/81 (70.4)
Age Years (mean; SD)
53.7 (10.3)
Males (n°; %)
57/81 (70.4)
Smokers (never/former/current) (n°; %)
42/17/19 (55.6/21/23.5)
Deaths (n°/death rate)
30/81 (37.0)
Mean Follow up time (months; SD)
24.7 (21.6)
HAEMATOLOGICAL DIAGNOSIS
Non Hodgkin’s Lymphoma (n°; %)
19 (23.5)
Hodgkin’s Lymphoma (n°; %)
5 (6.2)
Multiple Mieloma (n°; %)
55 (67.9)
Acute Mieloid Leukemia (n°; %)
2 (2.5)
PRE-TRANSPLANT FEATURES
Response to pre-transplant treatment
Partial response (n°; %)
52/81 (64.2)
Complete response (n°; %)
23/81 (28.4)
Stable disease (n°; %)
3/81 (3.7)
Disease progression (n°; %)
Patients exposed to pneumotoxic agents in pre-transplant treatment (n°; %)
39/81 (48.1)
Patients with lung abnormalities at the chest CT scan (n°; %)
19/81 (23.5)
POST-TRANSPLANT FEATURES
Major Infective Event (n° events/%)
43/81 (53.1)
Early Respiratory infections (within 100 days)
12/81 (14.8)
Late Respiratory infections (more than 100 days)
8/81 (9.9)

9. Results RESPIRATORY FUNCTION TEST FEV1 liters (mean; SD) 3.00 (0.76)
FEV1 liters (mean; SD)
3.00 (0.76)
FEV1 % of predicted (mean; SD)
97.4 (17.0)
FVC liters (mean; SD)
3.80 (0.89)
FVC % of predicted (mean; SD)
100 (16.4)
RV % of predicted (mean; SD)
87.6 (24.9)
TLC liters (mean; SD)
5.67 (1.27)
TLC % of predicted (mean; SD)
93.0 (14.2)
KCO (mean; SD)
2.95 (1.0)
KCO % of predicted (mean; SD)
57.9 (16.3)
Obstructed (n°; %)
7/81 (8.6)
Restricted (n°; %)
COMORBIDITIES
Cardiovascular disease (n°; %)
8/81 (9.9)
Diabetes Mellitus (n°; %)
12/81 (14.8)
Obesity (n°; %)
3/81 (3.7)
Previous history of neoplasm (n°; %)
6/81 (7.4)

10. Results 0.03 0.07 Survived Dead p-value FEV1 liters (mean; SD)
Survived
Dead
p-value
FEV1 liters (mean; SD)
3.1 (0.72)
2.8 (0.85)
0.19
FEV1 % of predicted (means; SD)
101.2 (15.4)
92.4 (18.6)
0.03
FVC liters (mean; SD)
3.90 (0.85)
3.65 (1.00)
0.26
FVC % of predicted (mean; SD)
104.2 (16.0)
95.6 (15.9)
RV % of predicted (mean; SD)
88.5 (20.2)
84.4 (29.6)
0.51
TLC liters (mean; SD)
5.64 (1.1)
5.71 (1.5)
0.83
TLC % of predicted (mean; SD)
95.3 (14.0)
89.4 (13.6)
0.10
DLCO % of predicted (mean; SD)
72.6 (19.9)
63.1 (12.9)
0.07
KCO (mean; SD)
3.22 (1.1)
2.52 (0.8)
KCO % of predicted (mean; SD)
59.7 (17.5)
54.3 (15.2)
0.32

11. Results Post-transplant pulmonary infection (all) No Yes p-value
FEV1 liters (mean; SD)
2.99 (0.75)
3.0 (0.76)
0.84
FEV1 % of predicted (means; SD)
98.7 (16.8)
96.3 (17.2)
0.53
FVC liters (mean; SD)
3.78 (0.94)
3.82 (0.85)
0.85
FVC % of predicted (mean; SD)
102.4 (16.3)
98.9 (16.5)
0.35
RV % of predicted (mean; SD)
91.5 (23.7)
85.0 (25.7)
0.30
TLC liters (mean; SD)
5.49 (1.2)
5.80 (1.3)
0.33
TLC % of predicted (mean; SD)
94.6 (16.2)
91.9 (12.9)
0.46
DLCO % of predicted (mean; SD)
72.2 (18.5)
67.7 (17.5)
0.43
KCO (mean; SD)
2.96 (1.4)
2.94 (0.8)
0.96
KCO % of predicted (mean; SD)
63.4 (20.9)
54.6 (12.2)
0.08
Post-transplant early pulmonary infection (within 100 days) No
Yes
p-value
FEV1 liters (mean; SD)
3.0 (0.77)
2.8 (0.69)
0.39
FEV1 % of predicted (means; SD)
98.6 (15.9)
90.1 (21.4)
0.11
FVC liters (mean; SD)
3.83 (0.92)
3.66 (0.74)
0.55
FVC % of predicted (mean; SD)
101.6 (16.0)
93.7 (18.0)
0.13
RV % of predicted (mean; SD)
88.8 (23.3)
80.2 (34.1)
0.34
TLC liters (mean; SD)
5.62 (1.26)
6.0 (1.3)
0.41
TLC % of predicted (mean; SD)
92.7 (14.6)
94.8 (11.9)
0.69
DLCO % of predicted (mean; SD)
68.7 (18.0)
72.6 (17.4)
0.58
KCO (mean; SD)
2.89 (1.11)
3.20 (0.86)
0.46
KCO % of predicted (mean; SD)
57.9 (17.4)
57.9 (11.1)
0.99
Post-transplant late pulmonary infection (more than 100 days) No
Yes
p-value
FEV1 liters (mean; SD)
3.0 (0.73)
2.9 (1.0)
0.86
FEV1 % of predicted (means; SD)
97.0 (17.6)
100.1 (10.0)
0.63
FVC liters (mean; SD)
3.81 (0.83)
3.73 (1.41)
0.80
FVC % of predicted (mean; SD)
100.4 (16.8)
101.1 (12.6)
0.90
RV % of predicted (mean; SD)
87.3 (24.8)
90.6 (27.7)
0.74
TLC liters (mean; SD)
5.71 (1.17)
5.36 (1.98)
0.66
TLC % of predicted (mean; SD)
93.3 (14.1)
0.64
DLCO % of predicted (mean; SD)
68.7 (18.0)
72.6 (17.4)
0.53
KCO (mean; SD)
2.96 (1.05)
2.89 (1.06)
0.89
KCO % of predicted (mean; SD)
56.7 (16.0)
66.8 (18.8)
0.20

12. Limitations
We ignore whether results obtained by Cyranose and by Bionote are fully comparable.
The number of patients studied allows hypothesize, but it cannot definitively prove, that OSAS patients segregate into two main groups with regard to basal BPs and CPAP related changes.
A testing population would make our results more solid. A broader population would definitively prove the role of comorbidity in determining VOCs spectrum and its changes after CPAP.
The classificatory role of comorbidity would be better defined by integrating the list of comorbid diseases with some index of severity of diseases.

13. Conclusions
In an OSAS population breath fingerprint dramatically changes after the first night of CPAP, suggesting immediate metabolic effects of nocturnal ventilation.
Comorbidity seems to play a primary role in conditioning such a change.
These findings might help to explain phenotypic variability in OSAS as well as to improve the monitoring of these patients.
Breath fingerprint might qualify as a mean of assessing in a very simple and inexpensive way the response and, later, the adherence to CPAP.

14. Thank you for your attention
Lung function prior to stem cell transplant as a predictor of infectious and pulmonary complications and survival in adults with haematologic malignancies
Thank you for your attention 14