Prognostic value of fev1q for the development of pulmonary complications after hematopoietic stem cell transplantation

SESSION TITLE: Late-Breaking Development in Lung Cancer, Lung Transplantation, and Pleural Disease SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:50 pm PURPOSE: Reductions in forced expiratory volume in 1 second (FEV1) are associated with increased risk of pulmonary complications after hematopoietic stem cell transplantation (HSCT). FEV1Q is the ratio of a patient’s FEV1 relative to the 1st percentile of lung function in adults with lung disease (0.4 L for women, 0.5 L for men). The prognostic value of FEV1Q for the development of pulmonary complications after HSCT has not been investigated. METHODS: We performed a multicenter retrospective cohort study at Mayo Clinic Transplant Centers in Rochester, MN and Jacksonville, FL. Pulmonary complications were identified via manual chart review and were categorized as infectious or noninfectious (e.g. ARDS, PERDS, DAH, BOS). Mortality was measured at 1 year post-transplantation. Ventilatory support was defined as the need for either non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). Frequency of the primary outcome (pulmonary complications) and secondary outcomes (mortality, need for ventilatory support) were modeled by FEV1Q using cutoff values from 1 to 10. An optimal cutoff was then determined using clinical and statistical significance. RESULTS: Between January 1, 2019 and December 31, 2020, 1,039 patients underwent HSCT, with 238 patients undergoing allogeneic HSCT and 801 patients undergoing autologous HSCT. Pulmonary complications occurred in 43.7% of allogeneic HSCTs and 11.6% of autologous HSCTs. In allogeneic HSCT, an FEV1Q threshold of 6 was associated with increased risk of pulmonary complications (58.2% vs. 36.5%, p=0.002), need for NIV/IMV (40.5% vs. 18.9%, p=0.001), and 1-year mortality (38.0% vs. 24.5%, p=0.045). In autologous HSCT, FEV1Q was associated with increased mortality (10.7% vs. 5.1%, p=0.004), but not pulmonary complications or need for ventilatory support. CONCLUSIONS: Use of a FEV1Q threshold >6 was associated with increased risk of pulmonary complications, need for NIV/IMV, and mortality in allogeneic HSCT. Use of FEV1Q cutoffs offers a convenient, easy to use, and significant measure for risk stratification in patients undergoing allogeneic HSCT. Larger and longer-term studies are needed to further investigate the role of FEV1Q for risk stratification. CLINICAL IMPLICATIONS: Pulmonary complications following HSCT remains a leading cause of morbidity and mortality. Identification of high-risk patients could improve early detection of pulmonary complications and more prompt interventions. Use of pre-transplant spirometry offers an easy and noninvasive way to potentionally identify at-risk patients, and the use of FEV1Q shows significant prognostic value in this retrospective review. DISCLOSURES: No relevant relationships by Mehrdad Hefazi No disclosure on file for Svetlana Herasevich No relevant relationships by Brad White No relevant relationships by Hemang Yadav No relevant relationships by Zhenmei Zhang