Lung function in survivors of childhood acute lymphoblastic leukemia.
OBJECTIVE
To evaluate lung function in patients cured from childhood acute lymphoblastic leukemia (ALL) with chemotherapy alone or plus bone marrow transplantation (BMT). Pulmonary toxicity is a well-recognized side effect of many ALL treatments.


METHODS
Cross-sectional study conducted at least 3 years after cessation of therapy.


METHODS
Outpatient pneumology department of the University Hospital.


METHODS
Forty-four subjects (age range at observation, 6 to 23 years): 21 treated only with intensive Berlin-Frankfurt-Munster (BFM)-type chemotherapy for newly diagnosed ALL (group A), and 23 treated with chemotherapy plus BMT (group B).


METHODS
A detailed history of smoking habit, respiratory symptoms, and diseases was recorded directly from the patients with the aid of their parents. A complete physical examination and lung function testing (lung volumes and diffusion capacity for carbon monoxide [DLCO]) were performed in all subjects.


RESULTS
No patient reported acute or chronic respiratory symptoms or diseases. In group A patients, lung function was in the normal range, except for three subjects in whom there was an isolated impairment of DLCO. In group B patients, lung function was markedly impaired, with more than half the patients having an abnormal DLCO. A statistically significant difference was found between the two groups for FVC (p = 0.022) and DLCO (p = 0.004).


CONCLUSIONS
Intensive, BFM-type frontline chemotherapy is not associated with late pulmonary dysfunction; however, retreatment including BMT can frequently injure the lung. Thus, in patients who undergo BMT and whose life expectancy is long, careful monitoring of lung function and counseling about avoiding additional lung risk factors is recommended.
Fulgoni
P
P
Institute of Respiratory Diseases, IRCCS Policlinico "S. Matteo," University of Pavia, Italy.
Zoia
M C
MC
Corsico
A
A
Beccaria
M
M
Georgiani
G
G
Bossi
G
G
Cerveri
I
I
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008168:Lung / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D009364:Neoplasm Recurrence, Local; D010045:Outpatients; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D011379:Prognosis; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D015996:Survival Rate