Chien J W, Martin P J, Flowers M E, Nichols W G, Clark J G
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
Bone Marrow Transplant. 2004 Apr;33(7):759-64. doi: 10.1038/sj.bmt.1704422.
The clinical significance of early airflow decline after myeloablative allogeneic hematopoietic SCT is uncertain. We performed a retrospective cohort analysis to determine if airflow decline by day 100 is associated with later development of transplant-related airflow obstruction (AFO) and increased mortality risk. Overall, 750 (40%) patients had airflow decline by day 100. Development of airflow decline by day 100 was associated with an increased risk for AFO at 1 year (relative risk 2.6, 95% confidence interval 2.1-3.1) but not with an increase in mortality risk (hazard ratio (HR) 0.86, P=0.05). However, patients with the fastest rate of decline between day 100 and 1 year (12.5% per year +/-24) had the highest mortality risk (HR 3.2, P<0.001). In conclusion, airflow measurements made on day 100 do not predict the rate of airflow decline between day 100 and 1 year, and therefore are not useful as a single measurement for determining mortality risk associated with development of AFO. Closer monitoring of the rate of airflow decline during the first year may facilitate the timely detection and treatment of early airflow decline and prevent the development of fixed AFO and increased mortality risk after hematopoietic stem cell transplant.
清髓性异基因造血干细胞移植后早期气流下降的临床意义尚不确定。我们进行了一项回顾性队列分析，以确定第100天时气流下降是否与移植相关气流阻塞（AFO）的后期发展及死亡风险增加有关。总体而言，750名（40%）患者在第100天时出现气流下降。第100天时出现气流下降与1年后发生AFO的风险增加相关（相对风险2.6，95%置信区间2.1 - 3.1），但与死亡风险增加无关（风险比（HR）0.86，P = 0.05）。然而，在第100天至1年期间下降速度最快的患者（每年12.5%±24）死亡风险最高（HR 3.2，P < 0.001）。总之，第100天进行的气流测量无法预测第100天至1年期间的气流下降速度，因此作为确定与AFO发展相关死亡风险的单一测量指标并无用处。在第一年更密切监测气流下降速度可能有助于及时发现和治疗早期气流下降，并预防造血干细胞移植后固定性AFO的发生及死亡风险增加。
