Respiratory function in children undergoing bone marrow transplantation

Abstract

We conducted a prospective study of respiratory function in children undergoing bone marrow transplantation (BMT) for onco‐hematological disorders. Each child was evaluated before and 100 days after BMT. The investigations included clinical examination, chest X‐ray, and pulmonary function tests (PFT) to determine: slow vital capacity (VC), functional residual capacity (FRC), total lung capacity (TLC), forced expiratory volume in 1 s (FEV1), carbon monoxide diffusing capacity (DLCO), ratio of residual volume (RV) to TLC, and FEV1/VC. The values obtained before and after BMT were compared to predicted values, and the post‐BMT values were compared to the pre‐BMT values (Student's t‐test). From 1986 to 1995, 77 children underwent BMT, of whom 39 were available for testing. The pre‐BMT VC (P = 0.0234) and DLCO (P < 0.0001) were lower and FRC higher (P < 0.0001) than predicted values. After BMT, the VC (P = 0.004), TLC (P = 0.044), and FEV1 (P = 0.012) were lower, and the RV/TLC ratio was higher (P = 0.043), compared with pre‐BMT data. The observed respiratory abnormalities were not clinically relevant. The only identifiable risk factor for a decrease in lung function was age at BMT. This study shows that some lung dysfunction may be present before BMT and be further altered by BMT. This stresses the need for longitudinal respiratory monitoring and follow up to detect such dysfunctions and to insure an optimal treatment program for these children. Pediatr Pulmonol. 1999; 28:31–38. © 1999 Wiley‐Liss, Inc.

Pulmonary function abnormalities after allogeneic marrow transplantation: a systematic review and assessment of an existing predictive instrument

“…Restriction was associated with GVHD in four studies, 16,22,23,30 and TBI, 16 single fraction TBI, 11 infection, 23 busulfan conditioning, 30 CMV seropositivity, 24 increasing age among pediatric patients 31 and age less than 18 years overall, 23 in one study each. Impairments of diffusion were associated with GVHD in four studies, 5,16,22,23 and TBI, 22 CMV seropositivity, 24 female sex, 34 infection, 23 smoking, 26 increasing age in pediatric patients, 31 age less than 18 overall, 23 T cell depletion 22 and chronic myelocytic leukemia 32 in one study each. GVHD was the most commonly identified risk factor, most often associated with obstruction, but also restriction and impaired diffusion.…”

“…Twenty studies presented PFT results in patients both before and at least 3 months after BMT and were reviewed in full. [3][4][5][6][7]11,16,[22][23][24][25][26][27][28][29][30][31][32][33][34] These reports provided information on up to 1786 allogeneic BMT patients. The exact number is unclear due to overlap in patient samples between studies, and incomplete description of numbers of patients with PFT data and allo-vs autoBMT.…”

“…Frequency, magnitude and time course of specific abnormalities are presented in Table Bone Marrow Transplantation 2. Twelve studies had fewer than 50 patients, 7,[22][23][24][25][26][27][28][31][32][33][34] four studies had 50-99 patients, 3,11,29,30 three studies had 100 or more patients, 4,5,16 and one study did not clearly state the number of patients with pre-and post-BMT PFTs. 3 Seven studies were limited to adults, 4,7,16,25,26,30,32 six studied only children, 6,24,27,28,31,34 five studied adults and children, 3,5,22,23,33 and the remaining two did not specify patient ages.…”

“…[5][6][7]33 Risk factors for the development of PFT abnormalities were identified in several studies, listed in Table 1. Obstruction was associated with GVHD in 12 studies, [4][5][6][7]11,16,22,26,29,30,32,33 increasing age at transplant in pediatric patients in two studies, 6,31 and increasing HLA mismatch, 6 leukemia, 33 busulfan conditioning 30 and alveolar capillary permeability, 25 in one study each. Restriction was associated with GVHD in four studies, 16,22,23,30 and TBI, 16 single fraction TBI, 11 infection, 23 busulfan conditioning, 30 CMV seropositivity, 24 increasing age among pediatric patients 31 and age less than 18 years overall, 23 in one study each.…”

“…Obstruction was associated with GVHD in 12 studies, [4][5][6][7]11,16,22,26,29,30,32,33 increasing age at transplant in pediatric patients in two studies, 6,31 and increasing HLA mismatch, 6 leukemia, 33 busulfan conditioning 30 and alveolar capillary permeability, 25 in one study each. Restriction was associated with GVHD in four studies, 16,22,23,30 and TBI, 16 single fraction TBI, 11 infection, 23 busulfan conditioning, 30 CMV seropositivity, 24 increasing age among pediatric patients 31 and age less than 18 years overall, 23 in one study each. Impairments of diffusion were associated with GVHD in four studies, 5,16,22,23 and TBI, 22 CMV seropositivity, 24 female sex, 34 infection, 23 smoking, 26 increasing age in pediatric patients, 31 age less than 18 overall, 23 T cell depletion 22 and chronic myelocytic leukemia 32 in one study each.…”