Prognostic implication of pre-transplant FEV1 on long-term outcomes following allogeneic hematopoietic stem cell transplantation
Igor Novitzky-Basso
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorWilson Lam
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorCaden Chiarello
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Search for more papers by this authorIvan Pasic
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorArjun D. Law
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorFotios V. Michelis
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorArmin Gerbitz
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAuro Viswabandya
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJeffrey H. Lipton
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorRajat Kumar
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJonas Mattsson
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorHans A. Messner
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorTheodore K. Marras
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
Search for more papers by this authorShikha Mittoo
University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
Involved Medicine, Toronto, Ontario, Canada
Search for more papers by this authorCorresponding Author
Dennis Dong Hwan Kim
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Correspondence
Dennis Dong Hwan Kim, Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9.
Email: [email protected]
Search for more papers by this authorIgor Novitzky-Basso
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorWilson Lam
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorCaden Chiarello
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Search for more papers by this authorIvan Pasic
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorArjun D. Law
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorFotios V. Michelis
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorArmin Gerbitz
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorAuro Viswabandya
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJeffrey H. Lipton
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorRajat Kumar
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorJonas Mattsson
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorHans A. Messner
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorTheodore K. Marras
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
Search for more papers by this authorShikha Mittoo
University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
Involved Medicine, Toronto, Ontario, Canada
Search for more papers by this authorCorresponding Author
Dennis Dong Hwan Kim
Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Correspondence
Dennis Dong Hwan Kim, Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9.
Email: [email protected]
Search for more papers by this authorIgor Novitzky-Basso and Wilson Lam contributed to this work equally as co-first authors.
Hans A. Messner deceased.
Abstract
Background
Pre-transplant pulmonary function testing (PFT) is essential before allogeneic hematopoietic stem cell transplant (HCT), yet the optimal cutoff value for affecting transplant outcomes remains poorly defined.
Study Design
Retrospective analysis of pre-HCT PFT data from 605 consecutive patients at the Princess Margaret Cancer Centre between January 1, 2004 and December 31, 2013 used binary recursive partitioning to identify cutoff values for overall survival (OS) as an endpoint of transplant outcomes. These values were compared to HCT comorbidity index (HCT-CI) FEV1 cutoffs for OS, cumulative incidence of relapse and non-relapse mortality.
Results
FEV1 ≥ 81% was the identified cutoff point. The OS rate at 3 years showed 49.8% (FEV1 ≥ 81%) vs. 36.6% (<81%, p < .001). For HCT-CI cutoffs, the OS rate at 3 years for FEV1 ≥ 80%, 66%–80% and ≤65% were 49.0%, 38.1% and 37.6% (p = .011), respectively. Multivariate analysis confirmed that FEV1 ≥ 81% predicted reduced mortality (HR 0.682, p = .001). Subgroup analysis showed both FEV1 ≥ 81% and FEV1 by HCT-CI cutoffs may stratify patients according to OS and NRM risk in subgroups receiving myeloablative, but not reduced intensity conditioning.
Conclusion
FEV1 ≥ 81% can predict OS and NRM in our cohort and is potentially simpler when risk stratifying patients undergoing allogeneic HCT, particularly those receiving myeloablative conditioning.
CONFLICT OF INTEREST STATEMENT
There are no conflicts of interest to disclose.
Open Research
DATA AVAILABILITY STATEMENT
Data can be made available on request, at the authors' discretion.
Supporting Information
| Filename | Description |
|---|---|
| ejh14062-sup-0001-TableS1.docxWord 2007 document , 13.4 KB | Table S1. Causes of death for all subjects. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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