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

Bone Marrow Transplant. 2014 May;49(5):622-7. doi: 10.1038/bmt.2014.15. Epub 2014 Feb 17.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravenous
  • Adult
  • Aged
  • Antilymphocyte Serum / administration & dosage
  • Busulfan / administration & dosage
  • Female
  • Follow-Up Studies
  • Hematologic Diseases / mortality
  • Hematologic Diseases / therapy*
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Lung Diseases / etiology
  • Lung Diseases / prevention & control*
  • Lymphocyte Depletion / methods*
  • Male
  • Middle Aged
  • Myeloablative Agonists / administration & dosage
  • Respiratory Function Tests
  • Retrospective Studies
  • Stem Cell Transplantation / adverse effects
  • Stem Cell Transplantation / methods*
  • Stem Cell Transplantation / mortality
  • Transplantation Conditioning / methods*
  • Transplantation Conditioning / mortality
  • Transplantation, Homologous
  • Vidarabine / administration & dosage
  • Vidarabine / analogs & derivatives
  • Young Adult

Substances

  • Antilymphocyte Serum
  • Immunosuppressive Agents
  • Myeloablative Agonists
  • Vidarabine
  • Busulfan
  • fludarabine