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Pulmonary Function in Pediatric Stem Cell Transplantation
Panuwat Srichaisawat1, Jitladda Deerojanawong2, Chanthana Harnruthakorn2
1Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; School of Pediatrics, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand.
Insights
Pediatric hematopoietic stem cell transplantation patients often have lung function issues. Post-transplant complications are linked to these defects, suggesting a need for close pulmonary monitoring.
Area of Science:
- Pediatric Hematology
- Pulmonology
- Transplantation Medicine
Background:
- Pulmonary complications are common after pediatric hematopoietic stem cell transplantation (HSCT).
- Limited data exists on pulmonary function in Thai pediatric HSCT recipients.
- This study addresses the need for data on pulmonary function and associated factors in this population.
Purpose of the Study:
- To assess pulmonary function in children undergoing HSCT in Thailand.
- To investigate pulmonary complications and their relationship with pulmonary function.
- To identify clinical factors associated with pre- and post-transplant pulmonary function defects.
Main Methods:
- Retrospective cohort study of children aged 6-18 years who underwent HSCT.
- Data collected between 1999 and 2020, focusing on accessible pulmonary function test results.
- Analysis of pulmonary function defects (diffusion, restrictive, obstructive) and complications.
Main Results:
- Abnormal pulmonary function was observed in 16.7%-20.8% pre-transplant and 8.3%-18.8% post-transplant.
- Pulmonary complications occurred in 33.3% of patients, primarily infections.
- Post-transplant complications correlated with post-transplant pulmonary function defects (aOR = 4.11, P = .02).
Conclusions:
- Pulmonary function defects and complications are prevalent in pediatric HSCT.
- Post-transplant pulmonary complications are associated with pulmonary function defects.
- Close pulmonary function monitoring is crucial, with potential for lung function decline post-complications.
Background:
Pediatric hematopoietic stem cell transplantation often results in pulmonary complications, yet limited data exist on pulmonary function in Thailand. This study aims to assess pulmonary function, investigating associated complications and identifying clinical factors linked to pre- and post-transplant pulmonary function defects.
Methods:
In this retrospective cohort study, we focused on children aged 6-18 years who underwent hematopoietic stem cell transplantation between 1999 and 2020, ensuring accessible pulmonary function tests results.
Results:
Among 48 patients, abnormal pulmonary function pre- and post-transplant (2-8 years) included a diffusion defect in 16.7% and 18.8%, a restrictive defect in 20.8% and 8.3%, and an obstructive defect in 4.2% and 10.4%, respectively. Pulmonary complications occurred in 16 patients (33.3%), including 15 infections and 1 case of bronchiolitis obliterans. While pretransplant pulmonary function defects were not significantly associated with specific characteristics, post-transplant pulmonary complications correlated with post-transplant pulmonary function defects (aOR = 4.11, 95% CI = 1.23-13.64, P = .02). Among the 6 patients with pre- and post-transplant follow-up, those with pulmonary complications showed a discernible decline in pulmonary function over time, while those without pulmonary complications remained stable or improved. However, the differences between these groups did not reach statistical significance (P = .13-.76).
Conclusions:
Prevalent pulmonary function defects and complications in pediatric hematopoietic stem cell transplantation highlight the importance of close pulmonary function monitoring. Post-transplant pulmonary complications are associated with defects, suggesting a potential trend of a subsequent decline in lung function, warranting further prospective validation.
