Effectiveness of long‐term routine pulmonary function surveillance following pediatric hematopoietic stem cell transplantation. Issue 11 (4th November 2013)

• Record Type: Journal Article
• Authors: Prais, Dario; Sinik, Moran Marx; Stein, Jerry; Mei‐Zahav, Meir; Mussaffi, Huda; Steuer, Guy; Hananya, Shai; Krauss, Aviva; Yaniv, Isaac; Blau, Hannah
• Is Part Of: Pediatric pulmonology. Volume 49:Issue 11(2014:Nov.)
• Page Start: 1124
• Page End: 1132
• Publication Date: 2013-11-04
• Subjects: Pediatric respiratory diseases -- Periodicals; Pediatrics -- Periodicals; 618.922
• DOI: 10.1002/ppul.22944
• Languages: English
• ISSNs: 8755-6863

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Summary</title> <sec id="ppul22944-sec-0001" sec-type="section"> <title>Introduction</title> <p>Pulmonary complications following hematopoietic stem cell transplantation (HSCT) are common and often subclinical. Thus, periodic pulmonary function testing (PFT) is mandatory.</p> <p>This study sought to evaluate the effectiveness of long‐term PFT surveillance for children undergoing HSCT and identify potential risk factors.</p> </sec> <sec id="ppul22944-sec-0002" sec-type="section"> <title>Methods</title> <p>We reviewed long‐term PFT for HSCT patients at a tertiary pediatric center. Inclusion criteria were PFT prior to and at least once following HSCT.</p> </sec> <sec id="ppul22944-sec-0003" sec-type="section"> <title>Results</title> <p>Fifty‐seven patients performed 202 spirometry and 193 plethysmographic maneuvers; 41 were tested during the first year after HSCT, but only 29 were evaluated consistently long term (2–12 years). FVC and FEV<sub>1</sub> decreased gradually suggesting a restrictive ventilatory defect: FVC % predicted [mean ± SD] dropped from 91 ± 14% to 85 ± 17% after 0–24 months and 80 ± 19% beyond 2 years (<italic>P</italic> = 0.01) whereas FEV<sub>1</sub> dropped from 95 ± 16% to 88 ± 19% and 82 ± 20%, respectively (<italic>P</italic> = 0.002). A slight reduction in TLC was observed.</p> <p>Those undergoing allogeneic HSCT had a greater decline in FVC (<italic>P</italic> = 0.025) and FEV<sub>1</sub> (<italic>P</italic> = 0.025) as did those conditioned with radiation, regarding both FVC (<italic>P</italic> = 0.003) and FEV<sub>1</sub> (<italic>P</italic> = 0.002). Decline occurred earlier (≤2 years) after chemotherapy compared with radiation. Seven children had severe irreversible obstruction at >2 years despite therapeutic intervention.</p> </sec> <sec id="ppul22944-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Most survivors of childhood HSCT maintain almost normal pulmonary function although mild restrictive lung disease may develop, particularly following allogeneic HSCT and conditioning with radiation. Severe airways obstruction developed in a small minority. The surveillance protocol for PFT needs to be followed more stringently to enable intervention possibly before early subclinical changes progress and become irreversible. <bold>Pediatr Pulmonol. 2014; 49:1124–1132.</bold> © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>