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Pulmonary function after treatment for acute lymphoblastic leukaemia in childhood
1Section of Paediatric Haematology and Oncology, GGK 4074, The Juliane Marie Centre, Rigshospitalet, Copenhagen.
Insights
Childhood acute lymphoblastic leukaemia survivors show reduced lung function years after treatment. Risk factors include younger age at treatment and intensive protocols, suggesting potential for late pulmonary toxicity.
Area of Science:
- Pediatric Oncology
- Pulmonology
- Clinical Research
Background:
- Childhood acute lymphoblastic leukemia (ALL) survivors may experience long-term health issues.
- Pulmonary complications are a known concern, but risk factors require further investigation.
Purpose of the Study:
- To assess pulmonary function in childhood ALL survivors.
- To identify risk factors associated with decreased lung function in this cohort.
Main Methods:
- A cohort of 94 childhood ALL survivors (no spinal irradiation or bone marrow transplant) was studied.
- Pulmonary function tests were compared to healthy controls.
- Median follow-up was 8 years post-therapy.
Main Results:
- Survivors exhibited mild, subclinical restrictive ventilatory insufficiency.
- Reduced lung transfer factor and transfer coefficient were observed.
- Younger age at treatment and intensive protocols (cranial irradiation, anthracyclines, cytarabine, cyclophosphamide) correlated with poorer lung function.
Conclusions:
- Childhood ALL survivors without bone marrow transplant or spinal irradiation show signs of restrictive lung disease.
- Increased treatment intensity in modern ALL protocols may increase the risk of late pulmonary toxicity.
Abstract:
The aim of this study was to examine pulmonary function after acute lymphoblastic leukaemia in childhood and identify risk factors for reduced pulmonary function. We studied a population-based cohort of 94 survivors of acute lymphoblastic leukaemia in childhood who were in first remission after treatment without spinal irradiation or bone marrow transplantation. Pulmonary function test results were compared with reference values for our laboratory, based on 348 healthy subjects who had never smoked from a local population study. A median of 8 years after cessation of therapy (range 1-18 years) the participants had a slight, subclinical, restrictive ventilatory insufficiency and reduced transfer factor and transfer coefficient. The changes in lung function were related to younger age at treatment and to more dose-intensive treatment protocols that specified more use of cranial irradiation and higher cumulative doses of anthracyclines, cytosine arabinoside and intravenous cyclophosphamide than previous protocols. We conclude that, 8 years after treatment without bone marrow transplantation or spinal irradiation, survivors of childhood acute lymphoblastic leukaemia in first remission were without pulmonary symptoms but had signs of slight restrictive pulmonary disease including reduced transfer factor. The increased dose intensity of many recent protocols for childhood acute lymphoblastic leukaemia may lead to increased late pulmonary toxicity.