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Recovery of Pulmonary Function after Allogeneic Hematopoietic Cell Transplantation in Children is Associated with
Ashok Srinivasan1, Anusha Sunkara2, William Mitchell3
1Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
Pulmonary function can normalize in children after allogeneic hematopoietic cell transplantation (HCT). Recovery of lung function is linked to better survival, highlighting the importance of managing pulmonary complications post-HCT.
Area of Science:
- Pediatric Hematology/Oncology
- Pulmonology
- Transplantation Medicine
Background:
- Abnormal pulmonary function is common in allogeneic hematopoietic cell transplantation (HCT) survivors.
- Pulmonary function recovery and its impact on survival in pediatric HCT recipients remain unclear.
Purpose of the Study:
- To investigate the patterns of pulmonary function recovery after pediatric allogeneic HCT.
- To determine the association between pulmonary function recovery and overall survival.
- To identify risk factors for pulmonary complications and mortality.
Main Methods:
- Retrospective cohort study of 308 children undergoing allogeneic HCT, followed for 10 years.
- Patients were divided into two groups: those with at least one abnormal pulmonary function test (PFT) post-transplantation and those with all normal PFTs.
- Analysis included PFT results, pulmonary complications, graft-versus-host disease, and survival data.
Main Results:
- Pulmonary function normalized in 27% of patients with initial abnormalities.
- Obstructive lung disease was the most common abnormality (43%) at a median of 5 years post-HCT.
- Patients who recovered pulmonary function demonstrated significantly better overall survival.
- Pulmonary complications and lower pre-transplantation forced vital capacity were linked to poor recovery.
- T cell depletion, lower pre-transplantation forced expired volume, and chronic graft-versus-host disease increased the risk of pulmonary complications.
Conclusions:
- Pulmonary function normalization is achievable in long-term pediatric allogeneic HCT survivors.
- Strategies aimed at reducing pulmonary complications are crucial for improving outcomes and survival.
- Nonrecovery of lung function, graft-versus-host disease, and mechanical ventilation are risk factors for nonrelapse mortality.
Abstract:
Abnormal pulmonary function is prevalent in survivors of allogeneic hematopoietic cell transplantation (HCT). Post-transplantation recovery of pulmonary function, and its effect on survival, in children are not known. This retrospective cohort study of 308 children followed for 10 years after HCT at a single institution included 2 groups of patients. Group 1 comprised 188 patients with 3 or more pulmonary function test (PFT) results, of which at least 1 was abnormal, and group 2 comprised 120 patients with 3 or more PFTs, all of which were normal. Pulmonary function normalized post-transplantation in 51 patients (27%) in group 1. Obstructive lung disease, restrictive lung disease, mixed lung disease, and normal pattern were seen in 43%, 25%, 5%, and 27% of patients, respectively, at a median of 5 years (range, 0.5 to 11.9 years) post-transplantation. Lung volumes recovered better than spirometric indices. Pulmonary complications were seen in 80 patients (43%) in group 1. Patients who recovered pulmonary function had better overall survival (P = .006), which did not differ significantly from that in patients in group 2 with normal lung function post-transplantation (P = .80). After adjusting for duration of follow-up, pulmonary complications (P = .01), and lower pretransplantation forced vital capacity z-scores (P = .01) were associated with poor recovery. T cell depletion (P < .001), lower pretransplantation forced expired volume in 1 second z-scores (P = .006), and chronic graft-versus-host disease (P < .001) increased the risk for pulmonary complications. Nonrecovery of lung function with pulmonary complications (P = .03), acute graft-versus-host disease (P = .004), and mechanical ventilation (P < .001) were risk factors for nonrelapse mortality. Normalization of pulmonary function is possible in long-term survivors of allogeneic HCT. Strategies to decrease the risk of pulmonary complications may improve outcomes.
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