Pulmonary dysfunction in survivors of childhood hematologic malignancies after allogeneic hematopoietic stem cell transplantation

• Published in: Cancer Vol. 116; no. 8; pp. 2020 - 2030
• Main Authors: Inaba, Hiroto, Yang, Jie, Pan, Jianmin, Stokes, Dennis C., Krasin, Matthew J., Srinivasan, Ashok, Hartford, Christine M., Pui, Ching‐Hon, Leung, Wing
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.04.2010
• Subjects: Adolescent; Adult; Age; Cancer; Child; childhood; Children; Diffusion; Female; Hematologic Neoplasms - physiopathology; Hematologic Neoplasms - therapy; Hematology; hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; leukemia; Lung; Lung - physiopathology; Lung Diseases - epidemiology; Lung Diseases - etiology; Male; Prospective Studies; pulmonary function; Respiratory function; Respiratory Function Tests; Respiratory Physiological Phenomena; Risk Factors; stem cells; survivor; Survivors; Transplantation, Homologous
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.24897

BACKGROUND: The number of long‐term survivors of allogeneic hematopoietic stem cell transplantation (allo‐HSCT) is increasing; however, few studies have addressed their long‐term pulmonary function. METHODS: The authors examined 660 baseline and follow‐up pulmonary function tests in 89 long‐term survivors of pediatric hematologic malignancies and allo‐HSCT. RESULTS: At least 1 abnormal lung parameter was seen in 40.4% of baseline tests and developed in 64% of post–allo‐HSCT tests (median follow‐up: 8.9 years). Abnormal baseline values in ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC), FEV1, residual volume (RV), functional residual capacity (FRC), and FVC were associated with abnormal post–allo‐HSCT values. The following pulmonary function values declined significantly with time: FEV1/FVC, forced mid‐expiratory flow (FEF25%‐75%), total lung capacity (TLC), diffusion capacity corrected for hemoglobin (DLCOcorr), RV, FRC, and RV/TLC. Older age at the time of allo‐HSCT was associated with lower FEV1/FVC, FEF25%‐75%, and DLCOcorr and higher RV/TLC. Patients who experienced respiratory events within 1 year post–allo‐HSCT had lower FEV1 and FVC values and higher RV/TLC from their baseline pulmonary function tests. Female patients had reduced FVC, TLC, and RV values but higher FEV1/FVC. Pulmonary dysfunction was also associated with high‐risk hematological malignancies and peripheral blood HSC product. CONCLUSIONS: Abnormal pulmonary functions in allo‐HSCT survivors are prevalent, which underscore the need for risk‐adapted continual monitoring and improved preventive and management strategies. Cancer 2010. © 2010 American Cancer Society. The authors examined baseline and follow‐up pulmonary function tests in long‐term survivors of pediatric hematologic malignancies and allogeneic hematopoietic stem cell transplantation (allo‐HSCT). We identified risk factors that are useful for risk‐adapted monitoring and counseling, including the abnormal pre–allo‐HSCT pulmonary function tests, interval from allo‐HSCT, patient age, respiratory event after allo‐HSCT, sex, leukemia‐risk group, and hematopoietic stem cell product.