Pulmonary dysfunction in survivors of childhood hematologic malignancies after allogeneic hematopoietic stem cell transplantation.
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 (FEV(1)/FVC), FEV(1), 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: FEV(1)/FVC, forced mid-expiratory flow (FEF(25%-75%)), total lung capacity (TLC), diffusion capacity corrected for hemoglobin (DLCO(corr)), RV, FRC, and RV/TLC. Older age at the time of allo-HSCT was associated with lower FEV(1)/FVC, FEF(25%-75%), and DLCO(corr) and higher RV/TLC. Patients who experienced respiratory events within 1 year post-allo-HSCT had lower FEV(1) and FVC values and higher RV/TLC from their baseline pulmonary function tests. Female patients had reduced FVC, TLC, and RV values but higher FEV(1)/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.
Inaba
Hiroto
H
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. hiroto.inaba@stjude.org
Yang
Jie
J
Pan
Jianmin
J
Stokes
Dennis C
DC
Krasin
Matthew J
MJ
Srinivasan
Ashok
A
Hartford
Christine M
CM
Pui
Ching-Hon
CH
Leung
Wing
W
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D019337:Hematologic Neoplasms / Q000503:physiopathology* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012143:Respiratory Physiological Phenomena; D012307:Risk Factors; D017741:Survivors; D014184:Transplantation, Homologous