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Author Spotlight: Exploring the Lifespan Dynamics of Healthy Human Hematopoiesis
Published on: December 8, 2023
High Prevalence of Abnormal Baseline Lung Function in Pediatric and Young Adult Hematopoietic Stem Cell Transplant
Jane Koo1,2, Richard Cooper2,3, Stephanie L Edwards2
1Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Insights
Preexisting lung problems in pediatric and young adult hematopoietic stem cell transplant (HSCT) patients are common and lead to worse outcomes. Early lung assessments are crucial for better survival and long-term respiratory health.
Area of Science:
- Hematology
- Pulmonology
- Transplant Medicine
Background:
- Pulmonary complications significantly impact morbidity and mortality in pediatric and young adult hematopoietic stem cell transplant (HSCT) recipients.
- The influence of pre-existing lung dysfunction on post-HSCT outcomes is not well understood.
Purpose of the Study:
- To investigate the prevalence and impact of pretransplant pulmonary dysfunction on outcomes in pediatric and young adult HSCT recipients.
- To assess the persistence of lung function impairments post-HSCT and their correlation with survival.
Main Methods:
- A prospective, multi-institutional cohort study included 444 patients (≤24 years) undergoing allogeneic HSCT.
- Baseline lung function was categorized using clinical history, imaging, pulmonary function tests (PFTs), and expert review.
- Spirometry and diffusion capacity were measured at baseline, Day 100, 1 year, and 2 years post-HSCT.
Main Results:
- 50.4% of patients had baseline pulmonary dysfunction, including impaired spirometry (46.4%) and reduced diffusion capacity (33.8%).
- Patients with pretransplant lung issues showed significantly lower FEV1, FVC, and DLCO z-scores (p < 0.001) and reduced overall survival (88.4% vs. 95.9%).
- Lung function deficits persisted up to 2 years post-HSCT, with seven respiratory-related deaths observed.
Conclusions:
- Pretransplant pulmonary dysfunction is prevalent and predicts persistent lung impairment and decreased survival in HSCT patients.
- Comprehensive baseline pulmonary assessment is vital for risk stratification.
- Early interventions guided by baseline assessments may improve long-term respiratory outcomes in this population.
Background:
Pulmonary complications are a major cause of morbidity and mortality in pediatric and young adult hematopoietic stem cell transplant (HSCT) recipients. The impact of preexisting lung dysfunction on posttransplant outcomes remains understudied.
Methods:
In a multi-institutional prospective cohort of 444 patients (≤24 years) undergoing allogeneic HSCT at eight centers, baseline lung function was categorized as normal or abnormal using clinical history, imaging, pulmonary function tests (PFTs), and pulmonologist review. Spirometry and diffusion capacity were assessed at baseline, Day 100, 1 year, and 2 years post-HSCT.
Results:
Baseline pulmonary dysfunction was present in 224 patients (50.4%), including impaired spirometry (46.4%), low diffusion capacity (33.8%), and imaging abnormalities (e.g., nodules 19%, interstitial changes 7.9%). These patients had significantly lower median z-scores for forced expiratory volume in 1 s (FEV1) (-2.3 vs. -0.5), forced vital capacity (FVC) (-2.0 vs. -0.3), and diffusion capacity of the lung for carbon monoxide (-2.4 vs. -0.7; all p < 0.001). Lung function impairments persisted through 2 years post-HSCT. FEV1 and FVC remained significantly lower at all time points; FEV1/FVC ratios were similar. Overall survival was lower in the abnormal group (88.4 vs. 95.9%). Seven respiratory-related deaths occurred, including acute respiratory distress syndrome (n = 3), respiratory failure (n = 2), diffuse alveolar hemorrhage (n = 1), and fibrotic lung disease (n = 1).
Conclusions:
Pretransplant pulmonary dysfunction is common and predicts sustained posttransplant impairment and lower survival. Comprehensive baseline assessment may aid in risk stratification and guide early interventions to improve long-term respiratory outcomes in pediatric and young adult HSCT patients.
Gov Identifier:
NCT04098445.
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