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Pulmonary Function Deficit and Clinical Associations in Childhood Acute Lymphoblastic Leukaemia Survivors: A National
Sonja Izquierdo Riis Meyer1,2, Birgitte Klug Albertsen2,3, Mette Tiedemann Skipper2,3
1Department of Paediatrics and Adolescent Medicine, Danish Centre of Paediatric Pulmonology and Allergology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Childhood acute lymphoblastic leukemia (ALL) survivors frequently experience pulmonary function deficit, particularly after stem cell transplantation or with pulmonary disease. Early detection through tailored monitoring is crucial for intervention.
Area of Science:
- Pediatric Oncology
- Pulmonology
- Clinical Research
Background:
- Childhood acute lymphoblastic leukemia (ALL) survival rates have improved significantly.
- Long-term pulmonary function deficits remain a significant concern for survivors.
- Understanding the prevalence and associations of these deficits is essential for improving care.
Purpose of the Study:
- To determine the prevalence of pulmonary function deficit in childhood ALL survivors.
- To identify abnormal pulmonary function test results in this population.
- To explore clinical associations with pulmonary function deficits.
Main Methods:
- A national retrospective cohort study was conducted.
- Included 295 eligible survivors aged 5-17.9 years.
- 185 survivors underwent pulmonary function testing at least 1 year post-treatment, with data analyzed for clinical associations.
Main Results:
- 37% of survivors exhibited pulmonary function deficit, highest in 15-17.9-year-olds (56%).
- Abnormalities were noted in diffusing capacity (37%), lung clearance index (29%), FEV1 (12%), and bronchodilator response (11%).
- Bronchiolitis obliterans, stem cell transplantation, and bronchiectasis were significantly associated with deficits.
Conclusions:
- Pulmonary function deficit is common in childhood ALL survivors.
- Stem cell transplantation and pre-existing pulmonary conditions increase risk.
- Long-term monitoring of small airway function and diffusing capacity is recommended for early detection and intervention.
Background:
Although survival for childhood acute lymphoblastic leukaemia (ALL) has improved, long-term pulmonary function deficit remains a concern. We aimed to explore the prevalence of pulmonary function deficit and abnormal pulmonary function tests in childhood ALL survivors and clinical associations.
Methods:
This national, retrospective cohort study (February 2019-May 2024) included eligible 5-17.9 year-old survivors (N = 295) who performed a valid pulmonary function test ≥ 1 year after treatment (N = 185). Clinical associations included treatment characteristics, pulmonary diagnosis, and radiological findings from medical charts.
Results:
Among 185 survivors, 37% (95% confidence interval (CI): [30, 45]) had pulmonary function deficit, with the highest prevalence (56%) among 15-17.9-year-olds. Abnormal test prevalence was 37% [27, 48] for diffusing capacity (carbon monoxide and/or nitric oxide), 29% [22, 38] for lung clearance index, 12% [8,18] for forced expiratory volume in the first second, and 11% [7, 17] for broncho-dilator response. Bronchiolitis obliterans, stem cell transplantation and CT-verified bronchiectasis were significant clinical associations of pulmonary function deficit (100%, 97.5% CI: [40, 100], 89% [76, 103], 73% [51, 96]) and abnormal diffusing capacity (100% (97.5% CI [29, 100]), 82% [59, 105], 75% [45, 105]), respectively. Bronchiectasis (88% [65, 110]) and transplantation (64% [39, 89]) were associated with a higher prevalence of abnormal lung clearance index. Bronchiolitis obliterans (75% [19, 99]) and transplantation (61% [39, 84]) were associated with a higher prevalence of abnormal forced expiratory volume in the first second.
Conclusions:
Pulmonary function deficit was frequent in childhood ALL survivors, especially after stem cell transplantation or pulmonary disease. Tailored long-term pulmonary monitoring, including small airway function and diffusing capacity, may aid in timely detection and intervention.
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