The effects of Bone Marrow transplantation on pulmonary function in children

Quigley, Patricia M.; Yeager, Andrew M.; Loughlin, Gerald M.

doi:10.1002/ppul.1950180604

Cited by 43 publications

(54 citation statements)

References 14 publications

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“…In earlier studies, in contrast, PFT were more likely to deteriorate when the recipient or donor was CMV positive 4 or when the recipient was CMV positive. 6 These discrepancies may be ascribable in part to the fact that we did not study donor CMV status.…”

Section: Discussionmentioning

confidence: 84%

“…This improvement could be explained by a decreased carbon monoxide diffusing capacity before BMT due to recent chemotherapy and by absence of significant alteration of carbon monoxide diffusing capacity at 2 years after BMT. Five studies 4,[6][7][8][9] found a significant decrease in this variable 8-12 months after BMT, followed by partial recovery. We cannot rule out a similar pattern in our patients, as we did not study diffusing capacity early after BMT.…”

Section: Discussionmentioning

confidence: 99%

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Effects of allogeneic bone marrow transplantation on pulmonary function in 80 children in a single paediatric centre

Bruno

Souillet

Bertrand

et al. 2004

Bone Marrow Transplant

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Summary:We retrospectively reviewed the results of serial pulmonary function tests (PFT) after allogeneic bone marrow transplantation (BMT) performed in 80 children at a single institution over a 16-year period. We looked for associations linking PFT results to graft-versus-host disease (GVHD), conditioning regimen (total body irradiation (TBI) vs busulphan), and cytomegalovirus immune status. The median follow-up after BMT was 4 years. At 2 years after BMT, significant declines were found in forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), as compared to baseline. Both FEV1 and the FEV1/FVC ratio showed significantly greater reductions in the group conditioned with busulphan (n ¼ 22) than in the group conditioned with TBI (n ¼ 49) and were significantly lower in the patients with (n ¼ 16) than without (n ¼ 64) chronic GVHD. Busulphan may be associated with greater long-term lung toxicity than TBI. The relevance of this finding to selection of conditioning regimens for BMT should be examined in the light of the overall pattern of side effects. Chronic GVHD was associated with airway obstruction. total body irradiation; busulphan; cytomegalovirus Bone marrow transplantation (BMT) has been used with increasing success in children with malignant and nonmalignant haematological diseases, which cannot be cured with conventional treatment. Major advances made in recent years have sharply increased the rate of long-term relapse-free survival after BMT in children. The corollary of this progress is a need for evaluation of the long-term effects of BMT on organ system function. Chronic pulmonary disease remains a major source of morbidity and mortality in children after BMT. [1][2][3][4][5] We reviewed serial pulmonary function tests (PFT) in children treated with allogeneic BMT at a single institution over a 16-year period. We examined the relationships linking graft-versushost disease (GVHD), conditioning regimen (total body irradiation (TBI) vs busulphan), and cytomegalovirus (CMV) immune status to the development of PFT abnormalities after BMT. Patients and methods Patient characteristicsWe retrospectively reviewed PFT data from children who underwent allogeneic BMT at the Debrousse Hospital between 1984 and 2000. A total of 80 children with at least PFT performed at a year after BMT were studied. The median follow-up was 4 years and minimum follow-up was 1 year. The main patient characteristics are shown in Table 1. Age at BMT, type of pretransplant conditioning regimen, CMV immune status of the recipient, and presence or absence of acute or chronic GVHD were recorded for statistical analyses. TBI consisted of two radiation sessions per day for 3 consecutive days, delivering 12 Gy in all. The lungs were shielded after 9 Gy. GVHD prophylaxis included cyclosporine plus methotrexate 15 mg/m 2 on day 1 after BMT and 10 mg/m 2 on days 3, 6, and 11. All the patients received cotrimoxazole for the first 12 months as Pneumocystis carinii prophylaxis. Whenever possible, PFT were obtained before BMT and...

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Effects of allogeneic bone marrow transplantation on pulmonary function in 80 children in a single paediatric centre

Bruno

Souillet

Bertrand

et al. 2004

Bone Marrow Transplant

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“…TBI has previously been associated with decreased lung volumes in adults, but data for children are conflicting. 6,7,[20][21][22] One reason for this may be the small sample sizes in pediatric studies and the heterogeneity with respect to TBI regimen. Single-fraction TBI has been associated with more marked decrease in lung volumes and less recovery in comparison with fractionated TBI.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary function after autologous bone marrow transplantation in children: a long-term prospective study

Frisk

Arvidson

Bratteby

et al. 2003

Bone Marrow Transplant

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Summary:We performed serial pulmonary function tests (PFTs) consisting of spirometry and diffusing capacity in 26 children after BMT. The median follow-up was 10 years. The influence of total body irradiation (TBI) on long-term pulmonary function was of particular interest. In the 20 children who had received TBI, after an initial decrease the PFTs showed recovery, but the mean lung volumes were still significantly decreased 5 years after BMT at 10% below baseline. The proportions of children with restrictive impairment 5 and 10 years after BMT were 20 and 21%, respectively. Only one child was diagnosed with obstructive impairment. The proportions of children with isolated diffusing impairment at 5 and 10 years were 7/20 (35%) and 7/13 (54%), respectively. Six children had received chemotherapy only and showed isolated diffusing impairment as the only long-term sequela in 4/5 and 1/3 at 5 and 10 years. Our main finding was that there was little change in PFTs 1-10 years after BMT. TBI was associated with persistently decreased lung volumes in a proportion of patients, whereas chemotherapy also might have been of importance for the development of impaired gas exchange.

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“…This is not surprising given that many fi rst-line chemotherapeutic agents such as cyclophosphamide, methotrexate, and cytosine arabinoside have been reported to cause lung toxicity. Quigley et al 99 reported a trend late effects among survivors of childhood cancer, the evidence indicates that some treatments necessary to cure malignancy contribute to long-term pulmonary dysfunction. Individual and combined treatment exposures to radiotherapy, bleomycin, alkylating agents, HSCT, and thoracic surgery increase the risk of later lung diseases.…”

Section: Other Risk-based Factors For Lung Damagementioning

confidence: 99%

“…43,45,46,48,49,52,55,99 The most commonly reported fi nding is a restrictive ventilatory defi cit, sometimes associated with a decrease in D lco . 40,42,43,45,[47][48][49]50,51,[53][54][55]58 In a cohort of survivors of childhood hematologic malignancies after allogeneic HSCT (n 5 89), Inaba et al 62 showed progressive worsening of pulmonary function measured with forced midexpiratory fl ow (25%-75%), residual volume, TLC, and D lco during a median follow-up of 8.9 years.…”

Section: Other Risk-based Factors For Lung Damagementioning

confidence: 99%

Pulmonary Outcomes in Survivors of Childhood Cancer

Huang

Hudson

Stokes

et al. 2011

Chest

138

137

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O ver the last 3 decades, therapeutic progress has resulted in a growing population of survivors of childhood cancer. In 2006, there were Ͼ 11 million cancer survivors in the United States, three times the number of survivors in 1971. 1 The 5-year survival rate for children diagnosed with cancer is approaching 85%, 2 and an estimated one in 570 individuals in the United States between the ages of 20 and 34 is a survivor of childhood cancer. 3 Unfortunately, increased survival rates are not without consequences. There is substantial evidence Background: The purpose of this article is to summarize the literature that documents the longterm impact of cancer treatment modalities on pulmonary function among survivors of cancer and to identify potential areas for further research. Methods: Systematic reviews of clinical trials, observational studies, case series, and review articles were conducted. Articles were limited to the studies that discussed pulmonary toxicity or late effects among pediatric cancer survivors and to follow-up investigations that were conducted a minimum of 2 years after completion of cancer-related treatment or 1 year after hematopoietic stem cell transplant. Results: Sixty publications (51 clinical studies/reports and nine reviews) published from January 1970 to June 2010 in PubMed met the inclusion criteria. Data showed an association between radiotherapy, alkylating agents, bleomycin, hematopoietic stem cell transplant, and thoracic surgery and pulmonary toxicity, as well as possible interactions among these modalities. Conclusions: Pulmonary toxicity is a common long-term complication of exposure to certain anticancer therapies in childhood and can vary from subclinical to life threatening. Pulmonary function and associated loss of optimal exercise capacity may have adverse effects on long-term quality of life in survivors. Lung function diminishes as a function of normal aging, and the effects of early lung injury from cancer therapy may compound these changes. The information presented in this review is designed to provide a stimulus to promote both observational and interventional research that expands our knowledge and aids in the design of interventions to prevent or ameliorate pulmonary late effects among survivors of childhood cancer. CHEST 2011; 140(4):881-901Abbreviations: ALL 5 acute lymphoblastic leukemia; BCNU 5 carmustine; CCNU 5 lomustine; D lco 5 diffusing capacity of the lung for carbon monoxide; GVHD 5 graft-vs-host disease; gy 5 gray; HL 5 Hodgkin's lymphoma; HSCT 5 hematopoietic stem cell transplant; NHL 5 non-Hodgkin's lymphoma; PFT 5 pulmonary function testing; TLC 5 total lung capacity

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The effects of Bone Marrow transplantation on pulmonary function in children

Cited by 43 publications

References 14 publications

Effects of allogeneic bone marrow transplantation on pulmonary function in 80 children in a single paediatric centre

Effects of allogeneic bone marrow transplantation on pulmonary function in 80 children in a single paediatric centre

Pulmonary function after autologous bone marrow transplantation in children: a long-term prospective study

Pulmonary Outcomes in Survivors of Childhood Cancer

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