Long-term pulmonary sequelae after treatment of childhood Hodgkin's disease

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Abstract
Background Pulmonary sequelae have been reported in patients treated for Hodgkin's disease (HD). Few data are available about patients treated for childhood HD followed over several years. Patients and methods In a cross-sectional study carried out for 76 months (median time) after treatment completion, we evaluated the lung function abnormalities and respiratory symptoms in 27 patients (16 males and 11 females) with HD diagnosed betweeen 1983 and 1994 (median age at diagnosis 11 years, range 2–16 years). They had been treated with chemotherapy and radiotherapy according to current protocol AIEOP-MH 83 ( n = 14) or AIEOP-MH 89 ( n = 13). At the time of the study, 26 patients were in first complete remission and one in second remission Of the 27 patients, 19 had had mediastinal irradiation at a dose of 20 Gy ( n = 5) or 20.8-44 Gy ( n = 14). Forced vital capacity (FVC), functional residual capacity (FRC), forced expiratory volume in one second (FEV 1 ), FEW 1 / FVC ratio, and maximal expiratory flow at 25% of FVC were registered; diffusion capacity for carbon monoxide (D L CO) was determined. Data were expressed as standard deviation (SD) score. Four patterns of respiratory function abnormalities were dehed: restrictive, obstructive, isolated bronchiolar imvairmat, isolated diffusing impairment. Results Twelve patients (44%) were asymptomatic and showed completely normal pulmonary function tests. Three patients reported dyspnea on exertion, and one of them also cough and phlegm: out of these symptomatic subjects, only 1 had hnctional abnormality (isolated D L CO impairment). A restrictive pattern was found in 5 patients (18%), including 2 who also had a pathological D L CO SD score. Eight additional patients (30%) had isolated diffusing impairment. Oxygen saturation was normal in all patients. Forty-seven percent of patients with normal D L CO had had lower dose irradiation (20 Gy) compared to 10% of patients with impaired D L CO ( P = 0.054). Similarly, patients with normal D L CO had had significantly less chemotherapy as compared to patients with abnormal D L CO ( P = 0.003). Occurrence of lung abnormalities was not significantly associated with sex, age at treatment, mediastinal irradiation, and time elapsed from treatment completion. Conclusions Adolescents and young adults treated for childhood HD are at risk for lung function abnormalities, significantly more frequent in patients who received more intense treatment, as mediastinal irradiation at a higher dose (>20 Gy) and more chemotherapy blocks. Long-term follow-up should be offered to these patients because of their possible limited potential for pulmonary function and possible lesser resistance to adverse agents such as smoke, pollution, infections, and aging.