Pulmonary function following allogeneic stem cell transplantation in childhood: A retrospective cohort study of 51 patients

Abstract

HSCT is associated with a high risk of late morbidity. The aim of this study was to evaluate the frequency, time frame, risk factors, and possible etiology of pulmonary dysfunction following allogeneic HSCT in childhood. We evaluated the pulmonary function of 51 HSCT patients (>6 yr), by including FVC and FEV1 values prior to (baseline) and annually up to five yr after HSCT. A Cox proportional hazards model was used to analyze the risk factors for a pulmonary event. Over half (59%) of the patients developed pulmonary dysfunction, mainly consisting of restrictive abnormalities. Acute GvHD (HR 4.31, 95% CI 1.47-12.63), chronic GvHD (HR 10.20, 95% CI 2.42-43.03), and an abnormal baseline pulmonary function (HR 4.82, 95% CI 1.02-22.84) were associated with post-transplant dysfunction. FEV1 (p < 0.001) and FVC (p < 0.001) declined significantly by 12 months after HSCT and both remained below the pre-HSCT level at up to four yr post-transplantation. HSCT in childhood is associated with early and persistent restrictive impairment of pulmonary function. Patients with extensive chronic GvHD are particularly vulnerable to severe pulmonary dysfunction. Scheduled pulmonary function testing is warranted as part of the follow-up of survivors of HSCT in childhood.

Longitudinal lung function in childhood cancer survivors after hematopoietic stem cell transplantation

“…Our results, with half of CCSs having at least one reduced pulmonary function parameter, are comparable to other studies (38–77%), with a follow-up of at least 5 years [ 1 – 3 , 26 – 28 ]. Differences in the study populations and in reporting of results may explain the variability between studies.…”

“…Literature on longitudinal course of pulmonary function in CCSs after HSCT is sparse and previous studies had only short follow-up periods of up to 6.8 years [ 3 , 4 , 11 , 12 ]. With this population-based retrospective cohort study we aimed to close this knowledge gap by describing pulmonary function trajectories up to 15 years from cancer diagnosis and to investigate predictors of pulmonary dysfunction in a cohort of long-term CCSs treated with HSCT.…”

Transplant characteristics and self-reported pulmonary outcomes in Swiss childhood cancer survivors after hematopoietic stem cell transplantation—a cohort study

“…In our cohort, we found no significant effect of other selected chemotherapeutics and transplant-related factors on the reporting of pulmonary outcomes. All studies that evaluated the impact of cGvHD on the lung, used pulmonary function tests as outcome measure [41][42][43][44]. They reported a negative effect of cGvHD on pulmonary function.…”

Pediatric pulmonology year in review 2017: Part 1

“…29 Abnormalities on pulmonary function testing are common after HSCT, 30 and need to be followed closely as they may predict complications. 31,32 In a small but important pilot study, Stark et al 33 tested a panel of four candidate genes for association with decreased FEV 1 and FEF 25-75% at one year after HSCT. They found a significant association with a single nucleotide polymorphism in the gene for glutathione-S-transferase P1 (GSTP1), a reported disease-modifying gene in childhood asthma.…”

“…Patients who receive hematopoietic stem cell transplant (HSCT) may develop both acute and chronic pulmonary complications . Abnormalities on pulmonary function testing are common after HSCT, and need to be followed closely as they may predict complications . In a small but important pilot study, Stark et al tested a panel of four candidate genes for association with decreased FEV 1 and FEF 25‐75% at one year after HSCT.…”