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Post-Transplant Complications

Pulmonary function abnormalities after allogeneic marrow transplantation: a systematic review and assessment of an existing predictive instrument

Bone Marrow Transplantation volume 30, pages 599–607 (2002)Cite this article

Abstract

Pulmonary function testing (PFT) is used to characterize non-infectious pulmonary complications after allogeneic BMT. Identifying high-risk patients could facilitate preventive or early therapeutic measures. The objectives of the study were first, to review available data on PFT changes after BMT and second, to validate a previously published predictive index for PFT obstruction in patients transplanted at one center. For the systematic review, frequency, severity and time course of PFT changes after BMT and for the validation study, retrospective cohort comparing predicted with observed PFT, and calculation of indices of predictive accuracy were summarized. The validation study involved 434 patients from Princess Margaret Hospital, Toronto, Canada, who received their first BMT between 1980 and 1997, survived for at least 6 months and had adequate PFT follow-up. The systematic review included 20 studies. After BMT, decreased diffusion and total lung capacity were common and partially reversible. Obstruction was less common. The validation study of a previously published index, performed in 434 patients, found a sensitivity and specificity of 48% and 68% for identifying patients who develop obstruction. We concluded that PFT changes after BMT are common. A published predictive index is not sufficiently accurate to identify high-risk patients for potential preventive or early therapeutic strategies.

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Acknowledgements

We wish to thank Dr Smita Pakhale, Ms Jessica Wright, and the late Dr Usha Senitharajah, for tireless efforts in data collection and entry, Dr Robert Hyland and Dr Michael Hutcheon for invaluable advice in the planning of the study and the medical records staff at the PMH. This project was supported by the Ontario Thoracic Society. Dr Marras is a Canadian Institutes of Health Research and Canadian Thoracic Society postdoctoral fellow and University of Toronto, Department of Medicine clinician scientist trainee. Dr Laupacis is a Senior Scientist of the Canadian Institutes of Health Research.

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Authors and Affiliations

  1. Joint Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Canada

    TK Marras & CK Chan

  2. Department of Research Design and Biostatistics, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Canada

    JP Szalai

  3. Department of Medicine, Bone Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Canada

    JH Lipton & HA Messner

  4. Institute for Clinical Evaluative Sciences, Toronto

    A Laupacis

  5. Department of Medicine, University of Toronto, Canada

    A Laupacis

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  1. TK Marras
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  6. A Laupacis
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Marras, T., Szalai, J., Chan, C. et al. Pulmonary function abnormalities after allogeneic marrow transplantation: a systematic review and assessment of an existing predictive instrument. Bone Marrow Transplant 30, 599–607 (2002). https://doi.org/10.1038/sj.bmt.1703700

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