Obstructive lung disease in children after allogeneic bone marrow transplantation

Abstract

Obstructive lung disease (OLD) has been described as a significant complication after allogeneic bone marrow transplantation (BMT). The incidence of OLD in adults appears to be low (approximately 3%), but there is little data for children. We analyzed 89 consecutive pediatric allogeneic BMTs, > or = 1.5 years post-BMT, performed at British Columbia's Children's Hospital from 1980 to 1992 for evidence of OLD. Diagnosis of OLD was based on clinical findings (nonproductive cough, wheezing, and dyspnea with no evidence of infection), pulmonary function tests (FEV1 < 80% and FEF25–75% < 60% predicted), lung biopsy, and computed tomography scan. Sixty-seven of the 89 children evaluated survived > or = 90 days and were classified as at risk for OLD. Thirteen of 67 (19.4%), developed OLD, 3 of which were transient. The development of OLD was strongly associated with the following high-risk groups: chronic graft-versus-host disease (GVHD) (37.1% OLD), increased donor age, acute GVHD, and either mismatched related or matched unrelated donor transplants. No correlation was found with methotrexate prophylaxis for GVHD, total body irradiation, or cytomegalovirus reactivity in either donor or recipient and the development of OLD. Further analysis of only children with chronic GVHD showed that liver involvement by GVHD before the onset of OLD (57.9%) was the only other significant predictive factor. We observed an overall increased prevalence of OLD in children compared with that previously reported in adults. Further studies are required to confirm whether age is a risk factor for development of OLD after allogeneic BMT.

Bronchiolitis obliterans following hematopoietic stem cell transplantation: a clinical update

“…The main risk factors for BO following HSCT are summarized in Table 2 (9–25, 27–30, 39–41). The presence of chronic GVHD is the most important association with BO.…”

“…In the minority of patients, the AFO progresses rapidly, and patients develop respiratory failure within a few months. However, some patients may have stabilization or even improvement in the AFO (17, 22).…”

Effect of reduced‐intensity conditioning and the risk of late‐onset non‐infectious pulmonary complications in pediatric patients

“…The clinical significance of LONIPCs should be discussed in terms of its association with the QOL of patients, because its clinical importance is increasing with improvement in the survival rate of SCT . However, the diagnostic procedure, clinical management, and treatment strategy are not well established so far, especially for children …”

“…Although steroids have been used and are reportedly effective for improving the symptoms and preventing deterioration, most LONIPCs are progressive . Sometimes it takes time for patients to present with clinical symptoms of LONIPCs, and thus, it is difficult to understand when and how they developed . Previous reports have indicated their association with the Bu regimen, cGVHD, older age, preceding BO, advanced stage of malignancy, viral infection early after transplantation, and rapid decrease in the dosage of immunosuppressants …”

“…However, this test is still difficult to perform in infants; we anticipate that other more simple clinical monitoring methods will become available . Although there are few reports about LONIPCs in pediatric patients, the same characteristics as those in adult patients have been reported, and the basic pathophysiology of LONIPCs seems relevant for pediatric and adult patients . Yet, the specific issues that differ for LONIPCs in adults are assumed for infants; however, the respiratory apparatus, including the alveolar vesicles and airway system, is still developing and growing during the infancy period.…”