Changing Clinical Practice and Predicting the Future: HCT Outcomes from a Pulmonary and Critical Care Perspective

2008 ASBMT Online Seminar
Jason W. Chien, MD, MS
Clinical Research Division
Fred Hutchinson Cancer Research Center
Pulmonary and Critical Care Medicine
University of Washington

Objectives: Bronchiolitis obliterans syndrome (BOS) has a low prevalence (1-2%) in the hematopoetic cell transplant (HCT) population. However, the mortality associated with BOS is significant; survival is 10% at five years. Early detection and then aggressive therapy can modify the death rate. Using standard pulmonary function tests (FEV 1 and DLco) and a Web-based calculator, it is possible to derive a pre-transplant assessment of mortality (PAM) which can alert to the potential for post-transplant clinical problems. Further evaluations of pulmonary function should be done three times in the first post-transplant year. Changes should be addressed immediately and aggressively. Clinical guidelines have been developed to direct management of HCT patients. Various clinical trials are in progress to determine if biomarkers and interventions can improve transplant outcomes.