Pretransplant pulmonary function predicts cytomegalovirus-associated interstitial pneumonia following bone marrow transplantation

Study Objective: To determine the value of pulmonary function tests (PFTs) in predicting the development of human cytomegalovirus (CMV)-associated interstitial pneumonia (IP) in allogeneic bone marrow transplant (BMT) recipients. Design: Nonrandomized, prospective, open-trial study. Setting: Tertiary referral medical center. Patients: 66 evaluable CMV-seropositive patients with hematologic malignancies who were undergoing allogeneic BMT. Intervention: FEV₁, FVC, FEV₁/FVC, TLC, Dco(c)/VA, PaO₂, and P(A-a)O₂ were measured on days -13, +33, and +44 following BMT. CMV-IP was diagnosed when typical roentgenographic findings developed with confirmatory positive bronchoalveolar lavage (BAL) using standard cytologic and/or rapid culture techniques. Measurement and Main Results: Univariate logistic regression analysis to predict the development of CMV-IP revealed significant associations with the day -13 and +33 percent predicted FEV₁, FVC, and TLC (p<0.01) but no associations with other PFT parameters or with changes in these parameters. Stepwise logistic regression analysis demonstrated that only BAL positivity for CMV (odds ratio 14.8; p = 0.0002) and day -13 percent predicted FEV₁ (odds ratio 0.92; p = 0.0004) were significant independent predictors of CMV-IP. Conclusion: Pretransplant lung function is a previously unrecognized strong predictor and risk factor for the subsequent development of CMV-IP in BMT recipients.