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Pulmonary function studies in children treated by chemoradiotherapy and stem cell transplantation

Authors

  • Ori Efrati MD,

    Corresponding author
    1. Pediatric Pulmonary Unit, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center (affiliated with Sackler School of Medicine), Tel-Aviv University, Ramat-Gan, Israel
    • Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel HaShomer, Ramat-Gan 52621, Israel.
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  • Amos Toren MD,

    1. The Hemato-Oncologic Department, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center (affiliated with Sackler School of Medicine), Tel-Aviv University, Ramat-Gan, Israel
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  • Hadar Duskin MD,

    1. The Hemato-Oncologic Department, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center (affiliated with Sackler School of Medicine), Tel-Aviv University, Ramat-Gan, Israel
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  • Dalit Modan-Moses MD,

    1. The Hemato-Oncologic Department, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center (affiliated with Sackler School of Medicine), Tel-Aviv University, Ramat-Gan, Israel
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  • Bella Bielorai MD,

    1. The Hemato-Oncologic Department, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center (affiliated with Sackler School of Medicine), Tel-Aviv University, Ramat-Gan, Israel
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  • Gal Goldstein MD,

    1. The Hemato-Oncologic Department, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center (affiliated with Sackler School of Medicine), Tel-Aviv University, Ramat-Gan, Israel
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  • Chaim Churi MD,

    1. The Hemato-Oncologic Department, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center (affiliated with Sackler School of Medicine), Tel-Aviv University, Ramat-Gan, Israel
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  • Daphna Vilozni PhD

    1. Pediatric Pulmonary Unit, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center (affiliated with Sackler School of Medicine), Tel-Aviv University, Ramat-Gan, Israel
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  • 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.

  • 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.

Abstract

Background

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.

Procedure

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.

Results

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.

Conclusion

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.

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