Abnormalities in lung function appear to influence outcomes in patients with hematological malignancies undergoing autologous hematopoietic stem cell transplantation (auto-HSCT), according to research published in Blood Advances.
According to the authors, organ dysfunction prior to high-dose chemotherapy followed by auto-HSCT in patients with hematological malignancies has not been well studied, despite the increased use of this therapy in patient with older age.
The investigators retrospectively analyzed the association of clinical factors and lung and cardiac function with outcome and complications after conditioning with BEAM (BCNU/carmustine, etoposide, cytarabine, and melphalan) or high-dose melphalan in patients undergoing auto-HSCT.
Between 2007 and 2017, a total of 629 patients with hematological malignancies were treated with auto-HSCT (conditioning regimen: BEAM, n=334; high-dose melphalan, n=295) at a single institution. Patients had a median age of 56 years (range, 19-78) in the BEAM group and 59 years (range, 29-74) in the high-dose melphalan group, and the median follow-up duration was 52 months (range, 0.2-152) and 50 months (range, 0.5-149) in the groups, respectively.
In patients treated with BEAM, the investigators found that progressive disease (hazard ratio [HR], 7.18; 95% CI, 4.14-12.4); P =.001), CO-diffusion capacity corrected for hemoglobin (DLCOcSB) ≤60% of predicted (HR, 2.47; 95% CI, 1.47-4.13; P =.001), Karnofsky Performance Status (KPS) ≤80% (HR, 1.89; 95% CI, 1.20-2.97; P =.005), Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score ≥4 (HR, 1.46; 95% CI, 0.94-2.28; P =.09), and age >70 years (HR, 2.13; 95% CI, 1.07-4.22; P =.03) were associated with decreased overall survival (OS).
In patients treated with high-dose melphalan, they found that DLCOcSB ≤60% of predicted (HR, 1.74; CI 95%, 0.92-3.28; P =.08), HCT-CI score ≥4 (HR, 2.11; 95% CI, 1.26-3.53; P =.004), and age >60 years (HR, 2.05; 95% CI, 1.28-3.26; P =.003) were associated with decreased OS.
The researchers also found that abnormalities in DLCOcSB ≤60% (vs >60%) of predicted were associated with chemotherapy with lung-toxic substances (BEAM group: 22 vs 8% P =0.01), mediastinal radiotherapy (BEAM group: 19 vs 6%; P =.006), KPS ≤ 80% (melphalan group: 72% vs 38%; P =.005), current/previous smoking (BEAM group: 31 vs 9%; P =.001; melphalan group: 63 vs 38%; P =.02), and treatment in the intensive care unit (BEAM group: 15 vs 4%; P =.001) and that patients with DLCOcSB ≤60% of predicted experienced nonrelapse mortality (BEAM group: subdistribution HR, 7.35; 95% CI, 3.28-16.4; P =.001).
Limitations of the study included data from a single institution and analysis of patients conditioned with BEAM or high-dose melphalan, and no other conditioning regimens.
“In summary, we identified several pulmonary function abnormalities as risk factors associated with decreased OS and increased [nonrelapse mortality] in patients conditioned with BEAM and high-dose melphalan prior to auto-HSCT,” concluded the authors. “These findings may lead to important preventive and early therapeutic interventions in patients undergoing auto-HSCT that will decrease morbidity and mortality further, [and] this study should help to identify a population at risk that might profit from less intense conditioning protocols to reduce mortality and improve outcome after auto-HSCT.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Duque-Afonso J, Ewald S, Ihorst G, et al. The impact of pulmonary function in patients undergoing autologous stem cell transplantation. Blood Adv. 2021;5(21):4327-4337. doi:10.1182/bloodadvances.2021004863