Effectiveness of long-term routine pulmonary function surveillance following pediatric hematopoietic stem cell transplantation

Dario Prais*, Moran Marx Sinik, Jerry Stein, Meir Mei-Zahav, Huda Mussaffi, Guy Steuer, Shai Hananya, Aviva Krauss, Isaac Yaniv, Hannah Blau

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Introduction: Pulmonary complications following hematopoietic stem cell transplantation (HSCT) are common and often subclinical. Thus, periodic pulmonary function testing (PFT) is mandatory. This study sought to evaluate the effectiveness of long-term PFT surveillance for children undergoing HSCT and identify potential risk factors. Methods: We reviewed long-term PFT for HSCT patients at a tertiary pediatric center. Inclusion criteria were PFT prior to and at least once following HSCT. Results: Fifty-seven patients performed 202 spirometry and 193 plethysmographic maneuvers; 41 were tested during the first year after HSCT, but only 29 were evaluated consistently long term (2–12 years). FVC and FEV1 decreased gradually suggesting a restrictive ventilatory defect: FVC % predicted [mean ± SD] dropped from 91 ± 14% to 85 ± 17% after 0–24 months and 80 ± 19% beyond 2 years (P = 0.01) whereas FEV1 dropped from 95 ± 16% to 88 ± 19% and 82 ± 20%, respectively (P = 0.002). A slight reduction in TLC was observed. Those undergoing allogeneic HSCT had a greater decline in FVC (P = 0.025) and FEV1 (P = 0.025) as did those conditioned with radiation, regarding both FVC (P = 0.003) and FEV1 (P = 0.002). Decline occurred earlier (≤2 years) after chemotherapy compared with radiation. Seven children had severe irreversible obstruction at >2 years despite therapeutic intervention. Conclusions: Most survivors of childhood HSCT maintain almost normal pulmonary function although mild restrictive lung disease may develop, particularly following allogeneic HSCT and conditioning with radiation. Severe airways obstruction developed in a small minority. The surveillance protocol for PFT needs to be followed more stringently to enable intervention possibly before early subclinical changes progress and become irreversible. Pediatr Pulmonol. 2014; 49:1124–1132.

Original languageEnglish
Pages (from-to)1124-1132
Number of pages9
JournalPediatric Pulmonology
Volume49
Issue number11
DOIs
StatePublished - 1 Nov 2014

Keywords

  • bone marrow transplantation
  • hematopoietic stem cell
  • lung function
  • spirometry

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