Pulmonary Function Test to Predict Pulmonary cGVHD

By Patrick Daly - Last Updated: December 20, 2022

Pulmonary chronic graft-versus-host disease (cGVHD), also called bronchiolitis obliterans syndrome (BOS), is one of the most dangerous complications of allogeneic hematopoietic stem cell transplantation (HSCT) and, according to a study published in BMC Pulmonary Medicine, is often diagnosed after lung dysfunction has become irreversible.

Researchers examined whether a pulmonary function test (PFT) prior to HSCT was able to identify patients who may be at risk and found the forced expiratory volume during 1 second to forced vital capacity (FEV1/FVC) and peak expiratory flow to predictive value (PEF/pred) ratios could be potential predictors for pulmonary cGVHD and even transplant outcomes.

The study included 923 allogeneic HSCT recipients from a single center, of which 15 later developed pulmonary cGVHD. Investigators used Kaplan-Meier and Cox regression models to assess 3-year progression-free survival and overall survival (OS).

The 3-year cumulative incidence of pulmonary cGVHD was 2.04% (95% CI, 1.00-3.08), according to the report. Based on receiver operating characteristic curve analysis, researchers found a higher FEV1/FVC ratio was associated with a lower incidence of pulmonary cGVHD (0.91%; 95% CI, 0.01-1.81 vs 3.61%; 95% CI, 1.30-5.92; P<.01). Likewise, a higher ratio of PEF/pred was correlated with a lower incidence of cGVHD (0.72%; 95% CI, 0-1.54 vs 3.74%; 95% CI, 1.47-6.01; P<.01).

Multivariate analysis established that FEV1/FVC (hazard ratio [HR], 3.383; P=.047) and PEF/pred (HR, 4.426; P=.027) were independent predictive variables for the onset of BOS. Higher FEV1/FVC and PEF/pred levels were associated with significantly decreased 3-year nonrelapse mortality. Of note, 3-year OS was superior in patients with higher PEF/pred (78.17%; 95% CI, 74.50-81.84 vs 71.14%; 95% CI, 66.08-76.20; P=.01), though patients with higher FEV1/FVC did not show the same difference.

“PFT is a routinely employed detection before HSCT, which may potentially predict the risk of pulmonary cGVHD and even transplant outcomes, according to our data,” the authors concluded.

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