Home Telemetric System for Pulmonary Function Surveillance: A Useful Procedure for Detection of Late-Onset Noninfectious Pulmonary Complications (LONIPC) after Allogeneic Hematopoietic Stem Cell Transplantation (HSCT).

Abstract

Late-onset noninfectious pulmonary complications (LONIPC) of allogeneic hematopoïetic stem cell transplantation (HSCT) occur in 2 to 25% of recipients. LONIPC include bronchiolitis obliterans (BrOb), which is associated with an obstructive syndrome, bronchiolitis obliterans with organizing pneumonia (BOOP) and interstitial pneumonia (IP), which are associated with a restrictive syndrome on pulmonary function tests. LONIPC have poor prognosis with death from respiratory failure in more than 30% of cases. We evaluated a telemetric system for home pulmonary function surveillance, for early diagnosis and treatment of LONIPC in allogeneic HSCT recipients.We conducted a prospective study of 35 patients living in Paris area, who survived over 3 months after HSCT (median age 46 years, myeloablative conditioning regimen in 54.2% of patients, HLA-identical sibling donor in 65.7%) between June 2001 and January 2004. Three months after HSCT, patients were delivered a portable spirometer (Spirotel®, M-Elect France), measuring vital capacity, forced expiratory volume per second, and mid expiratory flow 25 to 75 values. Data were transmitted by phone to hospital twice a week. If significant deterioration (>20%) was confirmed by plethysmography, then patients were admitted in Pneumology Department.Thirteen episodes of spirometric deterioration were detected in 11 patients during a median follow-up period of 18 months (1 to 42). LONIPC was diagnosed on spirometric, CT scan and broncho-alveolar lavage criteria during 8 episodes in 7/35 patients (20%), occurring after a median time of 11 months (6 to 18) after HSCT. One of these 7 patients had previously developed acute graft versus host disease (GVHD) and 5 had current chronic GVHD. LONIPC were BrOb, (n=3), interstitial pneumonia (n=4), or both BrOb and interstitial pneumonia (n=1). Patients were treated with increasing immunosuppressive regimens (prednisone and/or, mycophenolate mofetil, and/or cyclosporine A). Five patients improved and 2 were stabilised. There was no case of long-term oxygen therapy or death from respiratory failure (median follow-up 24 months (12 to 34) from LONIPC diagnosis). Telemetric home monitoring of pulmonary function is a reliable procedure easy-to-use for early diagnosis of LONIPC, which might improve the usual severe prognosis of LONIPC occurring after allogeneic HSCT.