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Respiratory function in children undergoing bone marrow transplantation
H Leneveu1, F Brémont, H Rubie
1Unité de Pneumo-Allergologie Pédiatrique, CHU Purpan, Toulouse, France.
Insights
Children undergoing bone marrow transplantation (BMT) may have pre-existing lung function issues. Post-BMT, lung function can change, highlighting the need for ongoing respiratory monitoring in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Hematology-Oncology
- Transplantation Medicine
Background:
- Bone marrow transplantation (BMT) is a critical treatment for onco-hematological disorders in children.
- Respiratory complications can impact outcomes post-BMT.
- Longitudinal assessment of pulmonary function is crucial for managing pediatric patients.
Purpose of the Study:
- To prospectively evaluate respiratory function changes in children before and after BMT.
- To identify potential risk factors affecting lung function post-transplantation.
- To emphasize the importance of continuous respiratory monitoring in this population.
Main Methods:
- Prospective study involving clinical exams, chest X-rays, and pulmonary function tests (PFTs).
- Evaluated parameters included vital capacity (VC), functional residual capacity (FRC), total lung capacity (TLC), forced expiratory volume in 1 s (FEV1), and carbon monoxide diffusing capacity (DLCO).
- Statistical comparison of pre-BMT, post-BMT, and predicted values using Student's t-test.
Main Results:
- Pre-BMT, children showed lower VC and DLCO, and higher FRC than predicted.
- Post-BMT, VC, TLC, and FEV1 decreased, while the RV/TLC ratio increased compared to pre-BMT values.
- Age at BMT was identified as the sole risk factor for decreased lung function; observed abnormalities were not clinically significant.
Conclusions:
- Lung dysfunction can be present before BMT and be altered by the procedure.
- Age at BMT is a significant factor influencing pulmonary function changes.
- Regular respiratory monitoring and follow-up are essential for optimizing treatment and outcomes in pediatric BMT recipients.
Abstract:
We conducted a prospective study of respiratory function in children undergoing bone marrow transplantation (BMT) for onco-hematological disorders. Each child was evaluated before and 100 days after BMT. The investigations included clinical examination, chest X-ray, and pulmonary function tests (PFT) to determine: slow vital capacity (VC), functional residual capacity (FRC), total lung capacity (TLC), forced expiratory volume in 1 s (FEV1), carbon monoxide diffusing capacity (DLCO), ratio of residual volume (RV) to TLC, and FEV1/VC. The values obtained before and after BMT were compared to predicted values, and the post-BMT values were compared to the pre-BMT values (Student's t-test). From 1986 to 1995, 77 children underwent BMT, of whom 39 were available for testing. The pre-BMT VC (P = 0.0234) and DLCO (P < 0.0001) were lower and FRC higher (P < 0.0001) than predicted values. After BMT, the VC (P = 0.004), TLC (P = 0.044), and FEV1 (P = 0.012) were lower, and the RV/TLC ratio was higher (P = 0.043), compared with pre-BMT data. The observed respiratory abnormalities were not clinically relevant. The only identifiable risk factor for a decrease in lung function was age at BMT. This study shows that some lung dysfunction may be present before BMT and be further altered by BMT. This stresses the need for longitudinal respiratory monitoring and follow up to detect such dysfunctions and to insure an optimal treatment program for these children.