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Lung function in children undergoing allo hematopoietic stem cell transplantation before the age of six
Colette Brac de la Perrière1, Julie Mazenq2, Caroline Thumerelle3
1Service de Pneumologie, Allergologie et CRCM pédiatrique. Hôpital Universitaire Robert Debré. Universié Paris Cité. Paris, France.
Insights
Lung function abnormalities persist in about one-third of children after hematopoietic cell stem transplantation (HSCT) before age six. Long-term respiratory monitoring is crucial, even in asymptomatic cases, due to potential transplant-related lung damage.
Area of Science:
- Pediatric Pulmonology
- Hematology
- Transplantation Medicine
Background:
- Limited data exists on lung function in children under six post-hematopoietic cell stem transplantation (HSCT).
- This age group is often excluded from respiratory function monitoring protocols.
- Understanding long-term pulmonary outcomes is critical for this vulnerable population.
Purpose of the Study:
- To describe long-term pulmonary function test (PFT) outcomes in children who received HSCT before age six.
- To identify factors associated with abnormal lung function post-HSCT.
- To establish baseline data for future respiratory care guidelines.
Main Methods:
- Retrospective analysis of the RESPPEDHEM cohort, including children undergoing HSCT before age six.
- Pulmonary function tests (PFTs) were analyzed more than 3 years post-HSCT.
- Abnormalities were defined using American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines.
Main Results:
- Thirty percent (12/40) of children exhibited abnormal lung function.
- The most common anomalies included obstructive and restrictive lung defects.
- Over 40% of children with lung abnormalities were asymptomatic.
Conclusions:
- Approximately one-third of children experience persistent lung function abnormalities after early HSCT.
- Systematic, long-term respiratory monitoring is recommended, irrespective of clinical symptoms.
- Lack of pre-HSCT PFTs in half the cohort limits definitive attribution of lung abnormalities to the transplant.
Background:
Data are lacking for lung evaluation after hematopoietic cell stem transplantation (HSCT) in children under the age of six, as this population cannot be included in respiratory function monitoring protocols.
Methods And Settings:
The RESPPEDHEM cohort included individuals under the age of 18 who underwent HSCT between January 2014 and November 2017. The eligible population for this study consisted of children from the RESPEDHEM cohort, who underwent HSCT before the age of 6, were still alive in October 2023 and had pulmonary function tests (PFTs) performed more than 3 years after HSCT. The primary objective of our multicenter study was to describe long-term PFT outcomes in children who received HSCT before the age of six, as included in the RESPEDDHEM cohort. The secondary objective was to identify clinical, radiological and transplant-related factors associated with abnormal lung function. Pulmonary abnormalities were defined according to the guidelines of the American Thoracic Society (ATS), the European Respiratory Society (ERS), and Global Lung Initiative (GLI).
Results:
Among the 40 children, the mean (SD) age at transplantation was 3.7 ± 1.4 years; 50 % had undergone PFT before HSCT. The last follow-up lung function test was performed at 10.2 ± 2.2 years. Twelve individuals (30 %; 95 %CI: 17-47 %) had abnormal lung function at the end of the study, based on the recent ERS/ATS technical standard on interpretive strategies for routine lung function tests. The main anomalies were obstructive defect (n=4) and restrictive defect (n=4).
Conclusion:
This study is the first lung function analysis of children undergoing HSCT before the age of six. Abnormalities persist in about one-third of the population, and 42 % of these children were asymptomatic. Therefore, systematic and long-term respiratory monitoring is needed even if the absence of clinical symptoms. However, half of the cohort did not undergo pre-HSCT pulmonary function testing, which limits the ability to attribute abnormalities solely to the transplant.
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