Carbon monoxide diffusion capacity: how low can you go for hematopoietic cell transplantation eligibility?

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Volume 15, Issue 4, p.447-53 (2009)

Keywords:

2009, Adult, Carbon Monoxide, Clinical Research Division, Diffusion, Female, Guidelines as Topic, Hematologic Neoplasms, hematopoietic stem cell transplantation, Humans, Male, Middle Aged, Respiratory Function Tests, Respiratory Insufficiency, Retrospective Studies, Risk Factors, Transplantation, Autologous, Transplantation, Homologous

Abstract:

Current guidelines suggest that patients with a pretransplantation diffusion capacity of the lung for carbon monoxide (DLCO) < or = 60% are not ideal candidates for hematopoietic cell transplantation (HCT); however, recent studies suggest this criterion may exclude patients who will benefit from the procedure. We conducted a study of all adult patients who underwent autologous or allogeneic HCT between 1990 and 2005, and had a DLCO < 60%, of predicted normal, to examine whether there is a lower limit for the DLCO threshold in the context of respiratory failure and nonrelapse mortality risk (NRM), and whether a comprehensive risk scoring system, such as the Pretransplant Assessment of Mortality (PAM) risk score, can more effectively risk stratify these patients with a very low pretransplantation DLCO. We found that among patients with a DLCO < or = 60% the risk of respiratory failure or NRM was not significantly different; however, the PAM score effectively risk-stratified these patients for NRM risk. There was a stepwise relationship between PAM score category and NRM risk; the highest PAM score category was associated with a 4.38-fold increase in risk (P < .001). These findings suggest that the pretransplantation DLCO should not be considered the sole eligibility criteria for allogeneic HCT.