Stable long-term pulmonary function after fludarabine, antithymocyte globulin and i.v. BU for reduced-intensity conditioning allogeneic SCT

Abstract

Lung function decline is a well-recognized complication following allogeneic SCT (allo-SCT). Reduced-intensity conditioning (RIC) and in vivo T-cell depletion by administration of antithymocyte globulin (ATG) may have a protective role in the occurrence of late pulmonary complications. This retrospective study reported the evolution of lung function parameters within the first 2 years after allo-SCT in a population receiving the same RIC regimen that included fludarabine and i.v. BU in combination with low-dose ATG. The median follow-up was 35.2 months. With a median age of 59 years at the time of transplant, at 2 years, the cumulative incidences of non-relapse mortality was as low as 9.7%. The cumulative incidence of relapse was 33%. At 2 years, the cumulative incidences of extensive chronic GVHD (cGVHD) and of pulmonary cGVHD were 23.1% and 1.9%, respectively. The cumulative incidences of airflow obstruction and restrictive pattern were 3.8% and 9.6%, respectively. Moreover, forced expiratory volume (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio remained stable from baseline up to 2 years post transplantation (P=0.26, P=0.27 and P=0.07, respectively). These results correspond favorably with the results obtained with other RIC regimens not incorporating ATG, and suggest that ATG may have a protective pulmonary role after allo-SCT.

Figures

Figure 1

Changes in PFT parameters from baseline up to 2 years post allo-SCT. Data are represented by boxplot. FEV1, FEV1/FVC, FVC, TLC, DLCO are expressed as percentage of predicted value.

Figure 2

Lung Function Score (LuFS) before allo-SCT, 100 days, 1 year and 2 years after allo-SCT. A separate score was assigned to relative values of FEV1 and DLCO (>80% = 1, 70–79% = 2, 60–69% = 3, 50–59% = 4, 40–49%=5, <40%=6), these scores were then summed and divided into four categories: LuFS 2 = category 0, LuFS 3–5 = category 1, LuFS 6–9 = category 2, LuFS 10–12 = category 3. No patient had severely abnormal lung function. There were no statistical differences in changes of LuFS before and after allo-SCT (Before allo-SCT vs 100 days (p=0.53), vs 1 year (p=0.29), vs 2 years (p=0.54)).