Pulmonary function after autologous bone marrow transplantation in children

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.