Pulmonary function impairment in children following hematopoietic stem cell transplantation

Authors

  • J. Wieringa MD,

    1. Department of Pediatric Immunology, Hemato-Oncology and Bone Marrow Transplantation (IHOB), Leiden University Medical Center, Leiden, The Netherlands
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  • K.W. van Kralingen MD, PhD,

    1. Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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  • J.K. Sont PhD,

    1. Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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  • D. Bresters MD, PhD

    Corresponding author
    1. Department of Pediatric Immunology, Hemato-Oncology and Bone Marrow Transplantation (IHOB), Leiden University Medical Center, Leiden, The Netherlands
    • Department of Immunology, Hemato-Oncology and Bone Marrow Transplantation (IHOBA) (J6S), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Abstract

Background

Deterioration of pulmonary function after hematopoietic stem cell transplantation (SCT) is a well-known late effect of this treatment, but the course of pulmonary function over time is less clear. The aim of our study was to establish both the prevalence and course of pulmonary function abnormalities in children following SCT.

Methods

Thirty-nine of 106 patients, who visited a post-SCT late effects clinic and who underwent a pulmonary function test (PFT) both before and at least twice after SCT were included in this study. Forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and total lung diffusion capacity (TLCO) were determined and recorded as percentage predicted for age, sex, and length matched controls. Values of less than 80% of predicted were considered abnormal. Change in PFT parameters over time was determined by comparing the mean PFT parameter in our group at three different time points: pre-SCT, ≤1 year post-SCT (SCTpost1) and >1 year post-SCT (SCTpost2).

Results

After SCT restrictive and/or diffusion abnormalities are most prevalent (45% and 76% at SCTpost1, respectively). A significant decrease of TLC (−9.7%) and TLCO (−20.3%) was observed during the first year after SCT, with improvement over time, but no normalization. Obstructive lung disease was less common (6% at SCTpost1). Clinical signs of lung function impairment were rare.

Conclusions

Restrictive and diffusion lung function disorders are common after SCT. They improve over time but do not normalize. As only a few patients with pulmonary function abnormalities had clinical signs of lung function impairment, the clinical relevance of performing long-term follow-up of PFT is questionable. © 2005 Wiley-Liss, Inc.

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