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Pulmonary function after autologous bone marrow transplantation in children: a long-term prospective study
P Frisk1, J Arvidson, L-E Bratteby
1Department of Women's and Children's Health, University Hospital, Uppsala, Sweden. per.frisk@kbh.uu.se
Insights
Pulmonary function tests (PFTs) in children post-bone marrow transplant (BMT) show minimal change 1-10 years later. Total body irradiation (TBI) is linked to reduced lung volumes, while chemotherapy may impact gas exchange.
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.
Abstract:
We performed serial pulmonary function tests (PFTs) consisting of spirometry and diffusing capacity in 26 children after BMT. The median follow-up was 10 years. The influence of total body irradiation (TBI) on long-term pulmonary function was of particular interest. In the 20 children who had received TBI, after an initial decrease the PFTs showed recovery, but the mean lung volumes were still significantly decreased 5 years after BMT at 10% below baseline. The proportions of children with restrictive impairment 5 and 10 years after BMT were 20 and 21%, respectively. Only one child was diagnosed with obstructive impairment. The proportions of children with isolated diffusing impairment at 5 and 10 years were 7/20 (35%) and 7/13 (54%), respectively. Six children had received chemotherapy only and showed isolated diffusing impairment as the only long-term sequela in 4/5 and 1/3 at 5 and 10 years. Our main finding was that there was little change in PFTs 1-10 years after BMT. TBI was associated with persistently decreased lung volumes in a proportion of patients, whereas chemotherapy also might have been of importance for the development of impaired gas exchange.
