Pulmonary function studies in children treated by chemoradiotherapy and stem cell transplantation

Area of Science:

• Pediatric Pulmonology
• Pediatric Oncology
• Hematology

Background:

• Pediatric patients with malignant and hematological diseases often experience pulmonary complications.
• Pulmonary function assessment is crucial for managing these patients.
• Identifying risk factors for pulmonary deterioration is essential for timely intervention.

Purpose of the Study:

• To assess pulmonary function at diagnosis and during a 5-year follow-up in pediatric hemato-oncology patients.
• To identify risk factors associated with pulmonary deterioration.
• To investigate the development of Bronchiolitis obliterans (BO) after stem cell transplantation and graft-versus-host disease (GVHD).

Main Methods:

• Ninety pediatric patients (age 3-20) with hematological or oncological diseases were enrolled.
• Pulmonary function testing, including spirometry, lung volumes, and diffusion capacity, was performed at diagnosis and at least twice during follow-up.
• Risk factors for pulmonary deterioration and development of BO were analyzed.

Main Results:

• Patients exhibited significantly lower spirometry, total lung capacity, functional residual capacity, and diffusion capacity values than predicted at diagnosis and during follow-up.
• The ratio of residual volume to total lung capacity (RV/TLC) was significantly higher than normal throughout the study.
• A subgroup of seven patients (8%) developed BO after stem cell transplantation and GVHD; these patients had lower baseline FEF25-75 (small airway disease) values, and their RV/TLC gradually increased.

Conclusions:

• Pediatric hemato-oncology patients present with reduced lung function at diagnosis.
• Abnormal baseline FEF25-75 values may indicate a risk for developing BO in the context of GVHD post-treatment.
• Close monitoring of FEF25-75 and RV/TLC at baseline and early post-diagnosis is recommended.