Pulmonary toxicity in patients with myeloma and lymphoma undergoing high dose chemotherapy and autologous stem cell rescue.

6677 Background: Eligibility determination for high dose chemotherapy and autologous stem cell rescue often includes pulmonary function testing (PFT). However, there is little current published information on the effects of commonly used high dose regimens on PFTs.,We retrospectively reviewed the charts of 100 patients who received either high dose melphalan for myeloma (n= 47) or the BCNU containing regimens BCV/BEAM for lymphoma (n= 53) and who had undergone pre-treatment and at least one post-treatment PFTs. Paired and independent T tests were used to ascertain statistical significance.,Patients receiving melphalan (200 mg/m) showed no significant change in their mean FVC, FEV1, and corrected DLCO [100% (range 76-133), 100% (76-142), 99% (68-166) of baseline, respectively] at 3 months post-transplant and a trend to improvement from baseline at 1 year that was significant in the case of FVC (p=0.02). Contrarily, patients receiving BCNU regimens showed significant decreases in mean FVC, FEV1, and DLCO at 3 mos. [92% (range 66-114; p<0.001), 95% (77-115; p<0.001), and 82% (47-113; p<0.001) of baseline, respectively]. By one year, FVC and FEV1 in lymphoma patients had recovered but DLCO, although improved to a mean of 89% (range 62-116) of baseline, remained significantly lower (p=0.003). Patients with lymphoma who had received prior mediastinal irradiation and/or bleomycin had greater decreases in the 3-month DLCO but these differences did not reach statistical significance. No detrimental effects on 3-month decreases were discernable for age, smoking history, the use of high dose cyclophosphamide in the mobilization regimen, amount of prior chemotherapy, or prior history of pulmonary disease such as pulmonary embolus and pneumonia.,On average, high dose melphalan produces little pulmonary toxicity. BCNU containing regimens should be used more cautiously. The relative contributions of measurement error and patient variability to the wide ranges are currently under study. More work should be directed at identifying the factors, other than the preparative regimens, that contribute to pulmonary function compromise following high dose regim ens. No significant financial relationships to disclose.