Pulmonary function after autologous bone marrow transplantation in children: a long-term prospective study

Area of Science:

• Pediatric Pulmonology
• Hematology
• Oncology

Background:

• Bone marrow transplantation (BMT) is a critical treatment for various pediatric diseases.
• Long-term pulmonary complications after pediatric BMT require thorough investigation.
• Understanding the impact of treatment modalities like total body irradiation (TBI) and chemotherapy on lung function is essential.

Purpose of the Study:

• To assess long-term pulmonary function in children following BMT.
• To investigate the specific effects of TBI and chemotherapy on pulmonary outcomes.
• To identify the prevalence of restrictive, obstructive, and gas exchange impairments post-BMT.

Main Methods:

• Serial pulmonary function tests (PFTs), including spirometry and diffusing capacity, were conducted.
• A cohort of 26 children post-BMT with a median follow-up of 10 years was studied.
• Data were analyzed to evaluate changes over time and correlate with treatment exposures (TBI, chemotherapy).

Main Results:

• Pulmonary function showed little change between 1 and 10 years post-BMT.
• Children who received TBI exhibited significantly decreased lung volumes (10% below baseline at 5 years) despite initial recovery.
• Restrictive impairment was observed in 20-21% of patients at 5 and 10 years. Isolated diffusing impairment affected 35% at 5 years and 54% at 10 years in TBI patients.
• Chemotherapy-only recipients showed isolated diffusing impairment in a significant proportion of cases.

Conclusions:

• Long-term pulmonary function after pediatric BMT is relatively stable but can be affected by treatment modalities.
• TBI is associated with persistent reductions in lung volumes.
• Chemotherapy may contribute to impaired gas exchange, highlighting the need for individualized monitoring.