Pre-hematopoietic stem cell transplant lung function and pulmonary complications in children.
BACKGROUND
Pulmonary complications are a significant cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation.


OBJECTIVE
The relationship between pretransplant pulmonary function tests (PFTs) and development of post-transplant pulmonary complications in children was studied.


METHODS
This is a retrospective single institution cohort study of 410 patients who underwent pretransplant PFT and were monitored to 10 years posttransplant.


RESULTS
Pulmonary complications were observed in 174 (42%) patients. Children with pulmonary complications had significantly lower forced expiratory flow at 25-75% of vital capacity (P = 0.02) derived using conventional predicted equations for age, and the Global Lung Initiative-2012 predicted equations (P = 0.01). T-cell depletion (P = 0.001), acute grade 3-4 graft-versus-host disease (P = 0.008), and chronic graft-versus-host disease (P = 0.01) increased risk for pulmonary complications. Patients who had pulmonary complications had a 2.8-fold increased risk of mortality (P < 0.0001). The cumulative incidence of death due to pulmonary complications was significantly higher in children who had low lung volumes, FRC less than 50% (P = 0.005), TLC less than 50% (P = 0.0002), residual volume less than 50% (P = 0.007), and T-cell depletion (P = 0.01). Lower FEV1 (P = 0.0005), FVC (P = 0.0005), TLC (P  <  0.0001), residual volume less than 50% (P = 0.01), and restrictive lung disease (P = 0.01) predicted worse overall survival.


CONCLUSIONS
Abnormal pretransplant PFT significantly increased risk after transplant. These patients may benefit from modified transplant strategies to reduce morbidity and mortality.
1 Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee.
Ashok
A
Srinivasan
Saumini
S
Srinivasan
Sudeep
S
Sunthankar
Anusha
A
Sunkara
Guolian
G
Kang
Dennis C
DC
Stokes
Wing
W
Leung
D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013714:Tennessee / Q000453:epidemiology; D014797:Vital Capacity; D055815:Young Adult
pediatric; post-transplant complications; pulmonary function