Long‐term morbidity of respiratory viral infections during chemotherapy in children with leukaemia

Abstract

Background Respiratory viruses are a common cause of infection in immunosuppressed children undergoing cancer therapy. Pulmonary sequelae have been documented following respiratory viral infections (RVIs) in hematopoietic stem cell transplant (HSCT) recipients; however potential late effects in children undergoing nonmyeloablative chemotherapy have not been investigated. Aim To evaluate the long‐term pulmonary morbidity of respiratory viral infections during chemotherapy in children with acute lymphoblastic leukemia (ALL). Methods Childhood ALL survivors, aged 7 to 18 years, greater than 6 months posttreatment were recruited. Exclusion criteria included HSCT or proven bacterial/fungal respiratory infection during treatment. Subjects were classified into “viral” or “control” groups according to retrospective medical records that documented the presence of laboratory‐proven RVIs during chemotherapy. Symptom questionnaires (Liverpool, ISAAC) and lung function testing (spirometry, plethysmography, diffusing capacity, forced oscillation technique to ATS/ERS standards) were then performed cross‐sectionally at the time of recruitment. Results Fifty‐four patients (31 viral, 23 control) were recruited: median (range) age 11.2 (7.2‐18.1) years, and at 4.9 (0.5‐13) years posttherapy. Abnormalities were detected in 17 (31%) individuals (8 viral, 9 control), with the most common being DLCO impairment (3 viral, 4 control) and reduced respiratory reactance at 5 Hz (5 viral, 6 control). Children with RVIs during chemotherapy reported more current respiratory symptoms, particularly wheeze (odds ratio [OR], 3.0; 95% confidence interval [CI]: 0.9‐10.0; P = .09) and cough (OR, 2.7; 95% CI: 0.8‐9.5; P = .11). No differences in lung function tests were observed between the two groups. Conclusions Our study found children with RVIs during chemotherapy developed more long‐term respiratory symptoms than controls; however, differences did not reach statistical significance. No differences in static lung function were found between the two groups. Overall, pulmonary abnormalities and/or significant ongoing respiratory symptoms were detected in nearly a third of ALL survivors treated without HSCT. Larger, prospective studies are warranted to evaluate the etiology and clinical significance of these findings.

Lung microbiome in children with hematological malignancies and lower respiratory tract infections

“…Consistent with previous studies (23,24), LRTI children with hematological malignancies were easier to get immunity and hemocyte exacerbations when attacked by LRTIs than other children with similar infectious conditions. In this study, children with malignancies turned out with significantly lower level of red blood cell count, hemoglobin, platelet count, and obviously higher level of C-reactive protein, ratio of a positive non-BALF culture, lower level of tidal volume per kilogram, and longer entire lower respiratory tract infection course and hospitalization course.…”

Avaliação da função pulmonar de pacientes oncológicos submetidos a quimioterapia

“…Outro fator particular nessa população foi a topografia das neoplasias manifestadas, pois apesar de o câncer de pulmão ser o mais incidente em números absolutos no mundo 20 , nossa amostra foi composta, em grande parcela, por pacientes com diagnóstico de câncer gástrico, o que é uma peculiaridade regional amazônida e do serviço de saúde onde a pesquisa foi realizada 24 Considerando as variáveis espirométricas analisadas neste estudo, não houve mudança significativa no decorrer dos 30 dias de exposição à quimioterápica antineoplásica. De forma semelhante, Lin et al 25 também observaram pequenas alterações sem significância estatísticas na função pulmonar de 54 pacientes com leucemia. Embora não houvesse significância estatística, o estudo ratifica que é possível observar anormalidades pulmonares até 13 anos pós o tratamento.…”

Pletismografia como recurso de avaliação respiratória em crianças e adolescentes: uma revisão sistemática

“…Seis estudos utilizaram a Pletismografia corporal como meio de avaliação (Kongkiattikul et al 2015;Pedersen et al 2016;Peradzyńska et al 2016;Lin et al 2019; Alzadegi et al 2020 e (Donoso, Hedenström, Malinovschi & Lilja, 2020 A Pletismografia faz parte do processo de exploração funcional respiratória, é um teste de que avalia os volumes pulmonares, de forma mais detalhada do que a espirometria (Aliverti et al 2003;Escobar & Jr, 2011). A medida desses volumes fornece informações para Research, Society and Development, v. 9, n. 12, e24691211134, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i12.11134 a caracterização dos distúrbios presentes nas doenças respiratórias (Escobar & Jr, 2011).…”

“…e Ryan, Rahman, Strang, Heinle, Shaffer, 2010), um da Suécia(Donoso, Hedenström, Malinovschi & Lilja,, 2020), dois da Espanha(Martín-Frías et al 2015 e Azaldegi, Korta, Sardón, Corcuera, Pérez-Yarza, 2020, um da Inglaterra(Hmeidi et at. 2016), um da Tailândia(Kongkiattikul, Sritippayawan, Chomtho, Deerojanawong & Prapphal, 2015), um da Austrália(Lin et al 2019), um da Polônia(Peradzyńska et al 2016), um da Dinamarca(Pedersen et al 2016) e por fim, um da Suíça (Yammie et al 2016). Os estudos seguiram as recomendações das diretrizes internacionais para a melhor obtenção dos resultados pulmonares.…”