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Published on: September 6, 2017
Pulmonary function impairment in children following hematopoietic stem cell transplantation
J Wieringa1, K W van Kralingen, J K Sont
1Department of Pediatric Immunology, Hemato-Oncology and Bone Marrow Transplantation (IHOB), Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
Insights
Pulmonary function abnormalities, particularly restrictive and diffusion issues, are common after hematopoietic stem cell transplantation (SCT) in children. While lung function improves, it rarely returns to normal, questioning the clinical value of long-term monitoring.
Area of Science:
- Pediatric Pulmonology
- Hematology
- Transplantation Medicine
Background:
- Pulmonary function deterioration is a known late effect of hematopoietic stem cell transplantation (SCT).
- The long-term trajectory of these pulmonary function changes in pediatric patients remains unclear.
Purpose of the Study:
- To determine the prevalence of pulmonary function abnormalities post-SCT in children.
- To describe the course of these abnormalities over time.
Main Methods:
- Pulmonary function tests (PFTs) were analyzed for 39 children before and at least twice after SCT.
- Key PFT parameters included FEV1, FVC, TLC, and TLCO, with values <80% considered abnormal.
- Changes were assessed at pre-SCT, within 1 year post-SCT (SCTpost1), and after 1 year post-SCT (SCTpost2).
Main Results:
- Restrictive and diffusion abnormalities were most common (45% and 76% at SCTpost1).
- Total lung capacity (TLC) and total lung diffusion capacity (TLCO) significantly decreased within the first year post-SCT.
- While PFT parameters improved over time, they did not normalize; obstructive disease was less frequent.
Conclusions:
- Restrictive and diffusion lung function disorders are prevalent following pediatric SCT.
- These abnormalities show improvement but not full normalization over time.
- The clinical significance of long-term PFT follow-up is questionable due to the rarity of clinical impairment signs.
Background:
Deterioration of pulmonary function after hematopoietic stem cell transplantation (SCT) is a well-known late effect of this treatment, but the course of pulmonary function over time is less clear. The aim of our study was to establish both the prevalence and course of pulmonary function abnormalities in children following SCT.
Methods:
Thirty-nine of 106 patients, who visited a post-SCT late effects clinic and who underwent a pulmonary function test (PFT) both before and at least twice after SCT were included in this study. Forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and total lung diffusion capacity (TLCO) were determined and recorded as percentage predicted for age, sex, and length matched controls. Values of less than 80% of predicted were considered abnormal. Change in PFT parameters over time was determined by comparing the mean PFT parameter in our group at three different time points: pre-SCT, < or =1 year post-SCT (SCTpost1) and >1 year post-SCT (SCTpost2).
Results:
After SCT restrictive and/or diffusion abnormalities are most prevalent (45% and 76% at SCTpost1, respectively). A significant decrease of TLC (-9.7%) and TLCO (-20.3%) was observed during the first year after SCT, with improvement over time, but no normalization. Obstructive lung disease was less common (6% at SCTpost1). Clinical signs of lung function impairment were rare.
Conclusions:
Restrictive and diffusion lung function disorders are common after SCT. They improve over time but do not normalize. As only a few patients with pulmonary function abnormalities had clinical signs of lung function impairment, the clinical relevance of performing long-term follow-up of PFT is questionable.
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