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Lung function abnormalities after bone marrow transplantation in children: has the trend recently changed?
I Cerveri1, P Fulgoni, G Giorgiani
1Clinic of Respiratory Diseases, Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico "San Matteo", Pavia, Italy. isa@mbox.systemy.it
Insights
Children undergoing bone marrow transplantation (BMT) for leukemia frequently develop early and late lung function abnormalities. Advanced disease phase and infections predict these pulmonary issues, which appear more severe than in the 1980s.
Area of Science:
- Pediatric Pulmonology
- Hematology/Oncology
- Transplantation Medicine
Background:
- Bone marrow transplantation (BMT) is a critical treatment for pediatric leukemias.
- Pulmonary complications are a significant concern following BMT.
- Understanding lung function changes is vital for long-term patient outcomes.
Purpose of the Study:
- To assess early and late lung function abnormalities in children post-BMT for leukemia.
- To identify predictors of pulmonary dysfunction after BMT.
- To compare findings with historical data from the 1980s.
Main Methods:
- Prospective cohort study of 75 children undergoing BMT for leukemia.
- Lung function tests and clinical exams performed pre-BMT and at 3-6, 12, and 24 months post-BMT.
- Analysis of autologous and allogeneic BMT recipients.
Main Results:
- High prevalence of altered lung function: 44% pre-BMT, 85% at 3-6 months, 62% at 24 months.
- Restrictive lung pattern most common between 3-6 months post-BMT.
- Predictors for late abnormalities included advanced disease phase (OR 6.75) and bronchopulmonary infections (OR 3.9).
Conclusions:
- A substantial number of children experience early and late pulmonary abnormalities after BMT for leukemia.
- Late pulmonary abnormalities appear more severe compared to the 1980s cohort.
- Intensified front-line leukemia treatments in the 1990s may contribute to increased pulmonary severity.
Study Objectives:
To evaluate early and late lung function abnormalities and their predictors in a large sample of children who underwent bone marrow transplantation (BMT) for leukemias in the 1990s, highlighting changes with respect to the 1980s.
Designs:
Prospective cohort.
Setting:
A university department of pediatrics.
Participants:
Seventy-five consecutive children who underwent BMT were enrolled in the study (median age, 11 years; range, 6 to 19 years; 45 male and 30 female children). Twenty-three children received autologous BMT, and 52 children received allogeneic BMT; 50 children completed the study.
Measurements:
Clinical examinations and lung function tests were performed before BMT, and 3 to 6 months, 12 months, and 24 months after BMT.
Results:
Before BMT, at 3 to 6 months after BMT, and at 24 months after BMT, 44%, 85%, and 62% of children, respectively, had altered lung function in the absence of persistent respiratory symptoms. Between 3 months and 6 months after BMT, a restrictive pattern was the most frequent abnormality. The only predictive factors for late abnormalities were transplantation performed in the advanced disease phase (odds ratio [OR], 6.75; p = 0.005) and bronchopulmonary infections (OR, 3.9; p < 0.05).
Conclusions:
These data suggest that a significant proportion of children who undergo BMT, especially if for leukemia in advanced phase, have early and late pulmonary abnormalities. These abnormalities, especially the late ones, seem to be more severe than patients reported in studies analyzing children undergoing BMT in the 1980s. This could be due to the more intensive front-line treatment protocols employed for treatment of children with acute leukemia in the 1990s.