Lung function abnormalities after bone marrow transplantation in children: has the trend recently changed?
OBJECTIVE
To evaluate early and late lung function abnormalities and their predictors in a large sample of children who underwent bone marrow transplantation (BMT) for leukemias in the 1990s, highlighting changes with respect to the 1980s.


METHODS
Prospective cohort.


METHODS
A university department of pediatrics.


METHODS
Seventy-five consecutive children who underwent BMT were enrolled in the study (median age, 11 years; range, 6 to 19 years; 45 male and 30 female children). Twenty-three children received autologous BMT, and 52 children received allogeneic BMT; 50 children completed the study.


METHODS
Clinical examinations and lung function tests were performed before BMT, and 3 to 6 months, 12 months, and 24 months after BMT.


RESULTS
Before BMT, at 3 to 6 months after BMT, and at 24 months after BMT, 44%, 85%, and 62% of children, respectively, had altered lung function in the absence of persistent respiratory symptoms. Between 3 months and 6 months after BMT, a restrictive pattern was the most frequent abnormality. The only predictive factors for late abnormalities were transplantation performed in the advanced disease phase (odds ratio [OR], 6.75; p = 0.005) and bronchopulmonary infections (OR, 3.9; p < 0.05).


CONCLUSIONS
These data suggest that a significant proportion of children who undergo BMT, especially if for leukemia in advanced phase, have early and late pulmonary abnormalities. These abnormalities, especially the late ones, seem to be more severe than patients reported in studies analyzing children undergoing BMT in the 1980s. This could be due to the more intensive front-line treatment protocols employed for treatment of children with acute leukemia in the 1990s.
Cerveri
I
I
Clinic of Respiratory Diseases, Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico "San Matteo", Pavia, Italy. isa@mbox.systemy.it
Fulgoni
P
P
Giorgiani
G
G
Zoia
M C
MC
Beccaria
M
M
Tinelli
C
C
Locatelli
F
F
D000293:Adolescent; D016026:Bone Marrow Transplantation; D002648:Child; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014797:Vital Capacity