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Pulmonary function after autologous bone marrow transplantation in children
J Arvidson1, L E Bratteby, K Carlson
1Department of Pediatrics, University Hospital, Uppsala, Sweden.
Insights
Pulmonary complications after pediatric autologous bone marrow transplant (ABMT) were minimal. Pulmonary function tests revealed modest, temporary decreases in lung capacity and volume, particularly after total body irradiation.
Area of Science:
- Pediatric Hematology/Oncology
- Pulmonology
- Stem Cell Transplantation
Background:
- Bone marrow autotransplantation (ABMT) is a critical treatment for pediatric cancers.
- Pulmonary complications can significantly impact outcomes post-ABMT.
- Understanding long-term pulmonary effects is crucial for patient management.
Purpose of the Study:
- To prospectively evaluate acute pulmonary complications in children undergoing ABMT.
- To assess changes in pulmonary function tests (PFTs) at various time points after ABMT.
- To analyze the impact of conditioning regimens, specifically total body irradiation, on pulmonary function.
Main Methods:
- Prospective study of 42 children receiving ABMT, focusing on pulmonary complications.
- Pulmonary function tests (PFTs) including TLC, VC, FEV1, and DLCO were performed pre-transplant and at 6, 12, 24, 36, and 60 months post-ABMT in 27 disease-free children.
- Comparison of PFTs based on conditioning regimens (with or without total body irradiation).
Main Results:
- Low incidence of acute pulmonary complications (1 case of interstitial pneumonitis) and no procedure-related mortality.
- Statistically significant decreases in TLC, VC, and FEV1 at 6 months post-ABMT in patients receiving total body irradiation, with incomplete recovery.
- Diffusion capacity of the lungs for carbon monoxide (DLCO) remained consistently low regardless of conditioning regimen.
Conclusions:
- Acute pulmonary complications following pediatric ABMT are infrequent.
- Modest, potentially long-lasting changes in lung function (TLC, VC, FEV1) may occur, particularly with total body irradiation.
- Long-term follow-up is essential to fully ascertain the pulmonary sequelae in pediatric ABMT survivors.
Abstract:
Forty-two children receiving bone marrow autografts were studied prospectively regarding acute pulmonary complications; there was no procedure-related mortality and only one case of interstitial pneumonitis. An analysis was also made of the pulmonary function tests (PFTs) of the 27 autografted children who were disease-free and had been followed up for at least 1 year (median 4.1 years, range 1.1-7.6 years). PFTs were performed before and 6, 12, 24, 36 and 60 months after autologous BMT. The mean pre-transplant values of total lung capacity (TLC), vital capacity (VC) and forced expiratory volume in one second (FEV1) were close to predicted but 6 months after autologous BMT there was a statistically significant decrease (11, 13 and 15% below baseline, respectively) in patients receiving total body irradiation in their conditioning regimen. There was some but not complete recovery with time. DLCO remained low throughout the study, irrespective of the conditioning regimen. In summary, acute pulmonary complications were few and PFTs showed only modest changes from baseline after ABMT. At the latest follow-up no respiratory symptoms had reportedly occurred in any of the children and the chest radiographs were normal. Although the results are promising so far, long-term follow-up is necessary to evaluate the final outcome in these children.