Pulmonary dysfunction in survivors of childhood hematologic malignancies after allogeneic hematopoietic stem cell transplantation

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Abstract
BACKGROUND: The number of long‐term survivors of allogeneic hematopoietic stem cell transplantation (allo‐HSCT) is increasing; however, few studies have addressed their long‐term pulmonary function. METHODS: The authors examined 660 baseline and follow‐up pulmonary function tests in 89 long‐term survivors of pediatric hematologic malignancies and allo‐HSCT. RESULTS: At least 1 abnormal lung parameter was seen in 40.4% of baseline tests and developed in 64% of post–allo‐HSCT tests (median follow‐up: 8.9 years). Abnormal baseline values in ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC), FEV1, residual volume (RV), functional residual capacity (FRC), and FVC were associated with abnormal post–allo‐HSCT values. The following pulmonary function values declined significantly with time: FEV1/FVC, forced mid‐expiratory flow (FEF25%‐75%), total lung capacity (TLC), diffusion capacity corrected for hemoglobin (DLCOcorr), RV, FRC, and RV/TLC. Older age at the time of allo‐HSCT was associated with lower FEV1/FVC, FEF25%‐75%, and DLCOcorr and higher RV/TLC. Patients who experienced respiratory events within 1 year post–allo‐HSCT had lower FEV1 and FVC values and higher RV/TLC from their baseline pulmonary function tests. Female patients had reduced FVC, TLC, and RV values but higher FEV1/FVC. Pulmonary dysfunction was also associated with high‐risk hematological malignancies and peripheral blood HSC product. CONCLUSIONS: Abnormal pulmonary functions in allo‐HSCT survivors are prevalent, which underscore the need for risk‐adapted continual monitoring and improved preventive and management strategies. Cancer 2010. © 2010 American Cancer Society.