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Airway reactivity in children before and after stem cell transplantation
Lea Bentur1, Moshe Lapidot, Galit Livnat
1Pediatric Pulmonary Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, Haifa, Israel. l_bentur@rambam.health.gov.il
Insights
Stem cell transplantation (SCT) can increase airway hyper-reactivity (AHR) in children, as shown by methacholine challenge tests (MCT). This increased AHR post-SCT is linked to a higher risk of pulmonary complications and hospitalizations.
Area of Science:
- Pediatric Hematology-Oncology
- Pulmonology
- Stem Cell Transplantation Research
Background:
- Stem cell transplantation (SCT) is a critical treatment for various pediatric hematological and oncological conditions.
- Pulmonary complications are a known risk following SCT, impacting patient recovery and long-term health.
- The potential for developing airway hyper-reactivity (AHR) post-SCT has not been extensively studied in pediatric populations.
Purpose of the Study:
- To investigate the incidence of increased airway hyper-reactivity (AHR) after SCT in pediatric patients.
- To assess the correlation between post-SCT AHR and the occurrence of pulmonary complications.
- To evaluate changes in airway obstruction using methacholine challenge tests (MCT) before and after SCT.
Main Methods:
- A prospective study involving pediatric patients undergoing SCT.
- Pulmonary function tests and methacholine challenge tests (MCT) were performed pre- and post-SCT.
- Systematic assessment and recording of all pulmonary complications and hospitalizations.
Main Results:
- A significant decrease in mean PC(20) values (indicating increased AHR) was observed post-SCT (P=0.018).
- The prevalence of AHR increased from 2/21 patients pre-SCT to 8/21 patients post-SCT (P=0.043).
- Patients with post-SCT AHR experienced a higher rate of pulmonary complications (62.5% vs 15.4%, P=0.041) and hospitalizations (median 1 vs 0, P=0.045).
Conclusions:
- Increased airway reactivity is a notable finding following pediatric SCT.
- Post-transplant AHR, identified via MCT, may serve as a predictive marker for pulmonary complications.
- Further research is warranted to elucidate the mechanisms behind AHR post-SCT and its clinical significance.
Abstract:
Stem cell transplantation (SCT) is associated with pulmonary complications. We encountered several children post-SCT with a clinical picture suggestive of airway hyper-reactivity (AHR) and evidence of reversible airway obstruction that was not reported pre-transplant.We evaluated the possibility of increased AHR as assessed by methacholine challenge test (MCT) following the course of SCT, and assessed a possible correlation between AHR and pulmonary complications.This was a prospective study evaluating consecutive patients referred for SCT to the Department of Pediatric Hemato-Oncology. Evaluation included pulmonary function test and MCT before and after SCT, and assessment of pulmonary complications.Twenty-one of 33 patients completed the study. The mean PC(20) was 14.3 +/- 4.1 mg/ml prior to SCT; afterward the mean PC(20) decreased to 11.2 +/- 5.6 mg/ml (P = 0.018). The number of patients with airway reactivity (PC(20) < or = 8 mg/ml) increased from 2/21 patients before SCT to 8/21 patients after SCT (P = 0.043; McNemar test with Yates correction). Pulmonary complications and hospitalization were recorded in 33.3% of the patients (7/21 patients): 62.5% of the patients (5 patients) with AHR compared to 15.4% (2 patients) in the group without AHR (P = 0.041; Fisher exact test). There were 10 hospitalizations among the 8 patients with positive MCT compared to 2 hospitalizations in 13 patients with negative MCT (median 1 vs. 0, P = 0.045; Mann-Whitney U-test).Increased airway reactivity was observed in our study following the course of SCT. Positive MCT after SCT may be associated with increased risk of pulmonary complications. Larger prospective studies are needed to evaluate the possible mechanisms responsible for increased AHR and the clinical importance of these findings.
