Testes de função pulmonar no transplante de células-tronco hematopoiéticas

Abstract

Background: The pulmonary function tests (PFT) are used in the assessment before hematopoietic stem cells transplantation (HSCT) and follow-up after HSCT. In addition to identifying non-infectious pulmonary complications (NIPC) after HSCT, may allow the adoption of preventive measures and early treatment in patients at risk. Although the achievement of the PFT is a guideline adopted internationally in the evaluation of these patients, the real benefit of these tests is not well established. Objectives: The purpose of this study was to evaluate prospectively the changes obtained in the PFT in HSCT patients at the Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG). To check the possible associations between the results of these tests with mortality and their importance in the diagnosis of NIPC after the procedure and still weigh about the usefulness of PFT in the assessment before HSCT. Methodology: It is a study that included patients older than 15 years, who underwent allogeneic hematopoietic stem cells transplantation from January 2007 to December 2008 at Hospital das Clínicas. These patients were submitted to spirometry, measurement of absolute lung volumes and carbon monoxide diffusion before HSCT, six months, one year and two years after HSCT. Results: Initially, 54 patients performed the PFT prior to HSCT, 34 after 100 days, 27 after one year and 21 after two years. The results of these tests showed that most patients (74%) had normal PFT before HSCT and even those who had changes of these tests were not prevented from receiving the transplant. And it was found still that only the time after two years when spirometry was analyzed separately and in 100 days and two years, in the analysis of all the PFT, was associated with changes in lung function. There was significant difference between the results of PFT when they were assessed only by spirometry and by spirometry associated with measurement of lung volumes and carbon monoxide diffusion. The incidence of NIPC in this study was 15% in two years. The results of this study showed a significant association between mortality and patients with abnormal spirometry before HSCT (RR = 3.2, 95% CI = 1.3 to 7.9, p < 0.012), unrelated donor (RR = 11.0 95% CI = 3.2 to 38, p = 0.001) and with preexisting lung disease (RR = 3.0, 95% CI = 1.04 to 8.8, p = 0.042) and a trend of association (RR = 2.3, 95% CI = 0.95 to 5.5, p = 0.058) when the analysis was performed with all the PFT. Conclusion: The PFT should be performed before HSCT to have a benchmark for comparison with tests after HSCT even the results of PFT before HSCT did not indicate against the transplantation procedure.