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The effects of bone marrow transplantation on pulmonary function in children
P M Quigley1, A M Yeager, G M Loughlin
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Pediatric bone marrow transplantation (BMT) can cause temporary lung function decline, particularly in the early months. However, pulmonary function tests (PFTs) often return to normal by 15 months post-BMT.
Area of Science:
- Pediatric Pulmonology
- Hematology
- Oncology
Background:
- Pulmonary function changes after pediatric bone marrow transplantation (BMT) are not well-documented.
- Understanding these effects is crucial for managing long-term health in childhood cancer survivors.
Purpose of the Study:
- To evaluate the serial pulmonary function tests (PFTs) in pediatric patients undergoing BMT.
- To identify factors influencing pulmonary function changes post-transplant.
Main Methods:
- Retrospective review of PFTs in 25 children (median age 9 years) before and at 6 and 15 months after allogeneic or autologous BMT.
- Analysis of factors including age, graft-versus-host disease (GVHD), cytomegalovirus (CMV) seropositivity, and preparative regimens.
Main Results:
- Most patients had normal PFTs pre-BMT.
- A transient decline in carbon monoxide diffusing capacity (DLCO) was noted early post-BMT, recovering by 15 months.
- Graft-versus-host disease (GVHD) and cytomegalovirus (CMV) seropositivity were linked to early pulmonary function decrements.
- Bulsulfan-based regimens showed less PFT impairment compared to others.
Conclusions:
- Pulmonary function abnormalities are common in the initial months after pediatric BMT.
- Lung function generally recovers by 15 months post-transplant.
- GVHD, CMV, and preparative regimens are key factors influencing early pulmonary outcomes.
Abstract:
The effects of current methods of bone marrow transplantation (BMT) on pulmonary function in children have not been extensively studied. We reviewed serial pulmonary function tests (PFTs) in 25 children (median age, 9 yr; range, 4-15) who received allogeneic (n = 14) or autologous (n = 11) BMT for neoplastic diseases at The Johns Hopkins Hospital. The PFTs were obtained before BMT and at 6 months (early) and 15 months (late) after transplant. In all but 6 patients, PFTs were normal before BMT. A mild transient decline in carbon monoxide diffusing capacity (DLCO) was observed early after BMT but returned to baseline levels in the late post-BMT period. A trend towards worsening of PFTs with increasing age of patients was observed. The presence of graft-versus-host disease (GVHD) and pretransplant seropositivity for cytomegalovirus (CMV) were associated with significant decrements in several measurements of pulmonary function in the early post-BMT period. Patients given bulsulfan-containing preparative regimens tended to have less impairment of PFTs than those given other regimens using other combination high-dose chemotherapeutic agents or total body irradiation. These findings suggest that abnormalities in PFTs are common in the first months after BMT in pediatric patients but are not consistently associated with impairment of lung function when studied 15 months post-transplant.