Principal investigators: Ori Efrati—In charge of the study. Amos Toren—clinical consultant for the study. Daphna Vilozni—in charge pulmonary functions tests; analysis of data; statistics and consultant for writing the article.
Article first published online: 12 AUG 2008
Copyright © 2008 Wiley-Liss, Inc.
Pediatric Blood & Cancer
Volume 51, Issue 5, pages 684–688, November 2008
How to Cite
Efrati, O., Toren, A., Duskin, H., Modan-Moses, D., Bielorai, B., Goldstein, G., Churi, C. and Vilozni, D. (2008), Pulmonary function studies in children treated by chemoradiotherapy and stem cell transplantation. Pediatr. Blood Cancer, 51: 684–688. doi: 10.1002/pbc.21722
Co-Investigators: Hadar Duskin, Dalit Modan-Moses, Bella Bielorai, Gal Goldstein and Chaim Churi contributed by recruiting children, analyzing the clinical data and correcting the written manuscript.
- Issue published online: 9 SEP 2008
- Article first published online: 12 AUG 2008
- Manuscript Accepted: 30 JUN 2008
- Manuscript Received: 20 DEC 2007
- Israel Lung Association, Tel-Aviv, Israel
- acute lymphoblastic leukemia;
- Hodgkin lymphoma;
- lung function tests;
- stem cell transplantation
Management of pediatric patients with malignant and hematological diseases is frequently associated with pulmonary complications. We assessed pulmonary function at diagnosis and during a 5-year follow-up to identify risk factors associated with pulmonary deterioration.
Ninety patients (age range 3–20) who were treated at the Pediatric Hematology-Oncology Department, Sheba Medical Center, Israel, were entered into the study. Pulmonary function testing was performed at diagnosis and at least twice during the study period.
At diagnosis and thereafter values of spirometry, total lung capacity, functional residual capacity and diffusion capacity were significantly lower than predicted (P < 0.002 for all indices). The ratio between residual volume and total lung capacity (RV/TLC) was significantly higher than normal at diagnosis and throughout the study (P < 0.001). Age and treatment modalities did not show any effect on lung-function during the study. A subgroup of seven patients (8%) developed Bronchiolitis obliterans (BO) after stem cell transplantation and development of graft versus host disease (GVHD). These patients' baseline FEF25–75 values (small airway disease) were significantly lower than FEF25–75 values of controls and other patients while all other parameters were similar. The RV/TLC in the BO patients gradually increased relative to other patients during the 5-year follow-up.
Lung-function in pediatric hemato-oncological patients at diagnosis is lower than predicted. Abnormal baseline FEF25–75 may be a risk factor for the development of BO in the setting of GVHD after treatment. Careful monitoring, especially of FEF25–75 and RV/TLC at baseline and in the first period after diagnosis. Pediatr Blood Cancer 2008;51:684–688. © 2008 Wiley-Liss, Inc.