The authors have no affiliations with any organization that has a direct interest in the subject of this study, and have not received grants or honoraria from corporations with a direct interest in this study, and as such, no conflicts to disclose.
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Research Article
Pre-transplant lung function is predictive of survival following pediatric bone marrow transplantation†
Article first published online: 28 OCT 2009
DOI: 10.1002/pbc.22337
Copyright © 2009 Wiley-Liss, Inc.
Additional Information
How to Cite
Ginsberg, J. P., Aplenc, R., McDonough, J., Bethel, J., Doyle, J. and Weiner, D. J. (2010), Pre-transplant lung function is predictive of survival following pediatric bone marrow transplantation. Pediatr. Blood Cancer, 54: 454–460. doi: 10.1002/pbc.22337
- †
Publication History
- Issue published online: 7 JAN 2010
- Article first published online: 28 OCT 2009
- Manuscript Accepted: 21 SEP 2009
- Manuscript Received: 6 JUL 2009
- Abstract
- Article
- References
- Cited By
Keywords:
- late effects of cancer treatment;
- pulmonary function testing;
- stem cell transplantation
Abstract
Background
Pulmonary toxicity is well described in recipients of bone marrow transplants (BMT), and accounts for a sizeable proportion of post-transplant mortality. The majority of the data on post-transplant pulmonary function is from adults, although several small pediatric case series have been described. In adults, pre-transplant lung function has been predictive of post-transplant respiratory failure and mortality. This use of pulmonary function testing, that is, for pre-transplant risk counseling, is novel but has never been applied to pediatric patients. We hypothesized that in children, as in adults, pre-transplant pulmonary function would also be predictive of outcome post-transplantation morbidity.
Procedure
Retrospective database analysis of pulmonary function tests of patients undergoing first myeloablative BMT at two large children's hospitals.
Results
Two hundred seventy-three subjects had at least one pre-transplant PFT, and 317 subjects had at least one post-transplant PFT available for analysis. While the majority of patients had normal or mildly reduced pre-transplant flows and lung volume, 25% had moderately or severely reduced diffusion. All lung function parameters decreased post-transplant with a slow improvement over ensuing years. The Lung Function Score, a combined measurement of FEV1 and DLCO, was highly associated with post-transplant survival. Hazard ratios for mortality (compared to the best LFS) ranged from 1.654 to 2.454.
Conclusions
Lung function prior to bone marrow transplant, especially diffusing capacity, is frequently abnormal. Lung function frequently decreases shortly post-transplant and tends to improve over time, but frequently remains abnormal even years after transplant. Post-transplant survival is related to pre-transplant lung function. Pediatr Blood Cancer 2010;54:454–460. © 2009 Wiley-Liss, Inc.