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Late effects of bone marrow transplantation on pulmonary function in children
E B Kaplan1, R A Wodell, R W Wilmott
1Department of Pediatrics, North Shore University Hospital.
Insights
Pediatric bone marrow transplantation (BMT) for leukemia/lymphoma patients showed significant pulmonary function decline, unlike those treated for aplastic anemia. This suggests a restrictive lung process in the former group post-BMT.
Area of Science:
- Pediatric Pulmonology
- Hematology
- Transplantation Medicine
Background:
- Bone marrow transplantation (BMT) is a critical treatment for various pediatric hematologic conditions.
- Late pulmonary effects after BMT can impact long-term patient health and quality of life.
- Understanding differences in pulmonary outcomes based on the underlying disease treated is crucial for patient management.
Purpose of the Study:
- To compare late pulmonary function effects in pediatric patients undergoing BMT for acute leukemia/lymphoma versus aplastic anemia.
- To identify specific changes in lung function parameters (FEV1, FVC, FEF25-75, TLC) over time post-BMT.
- To investigate potential differences in the development of pulmonary abnormalities between these patient groups.
Main Methods:
- Retrospective analysis of pulmonary function tests in 46 pediatric patients.
- Comparison of lung function parameters (FEV1/FVC, % predicted FEV1, FVC, FEF25-75, TLC) pre-BMT and up to 7 years post-transplant.
- Stratification of patients based on indication for BMT: acute leukemia/lymphoma vs. aplastic anemia.
Main Results:
- No significant differences in pulmonary function were observed between the leukemia/lymphoma and aplastic anemia groups pre-BMT or up to 7 years post-transplant.
- Patients treated for acute leukemia or lymphoma showed a significant decline in FVC, FEV1, and FEF25-75 from pre-BMT to 9-12 months and 18-24 months post-BMT.
- A greater decline in FVC relative to FEV1 within the leukemia/lymphoma group suggests the development of a restrictive pulmonary process.
Conclusions:
- Pediatric patients undergoing BMT for acute leukemia or lymphoma experience significant declines in lung function post-transplant, indicative of a restrictive process.
- Pulmonary function outcomes do not significantly differ between pediatric BMT for leukemia/lymphoma versus aplastic anemia groups in the long term.
- Close monitoring for restrictive lung disease is warranted in pediatric patients treated with BMT for acute leukemia or lymphoma.
Abstract:
This study was undertaken to evaluate in a primarily pediatric population whether the late effects of bone marrow transplantation (BMT) on pulmonary function in patients having undergone the procedure for treatment of acute leukemia or lymphoma are worse than that of patients having undergone transplant for treatment of aplastic anemia. Forty-six patients were studied. We did not demonstrate statistically significant differences in group mean forced expiratory flow in one second/forced vital capacity (FEV1/FVC) and percentage predicted forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% of the forced vital capacity (FEF25-75) and total lung capacity (TLC) values between the two groups of patients before BMT and to 7 years post-transplant. Individual patients with pulmonary function abnormalities were identified. Furthermore, there were no significant differences between the two study groups or within the group of patients with aplastic anemia from pre-transplant to 9-12 months and from pre-transplant to 18-24 months after BMT. However, within the group of patients treated for acute leukemia or lymphoma, there was a significant decline in the group mean percentage predicted FVC (p = 0.0001), FEV1 (p = 0.0006) and FEF25-75 (p = 0.0063) from pre-transplant to 9-12 months and in the FVC (p = 0.004) and FEV1 (p = 0.0006) from pre-transplant to 18-24 months after BMT. The greater decline in the FVC relative to the FEV1 suggests the development of a restrictive process in this group of patients.