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

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 (FEV 1 /FVC), FEV 1 , 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: FEV 1 /FVC, forced mid‐expiratory flow (FEF 25%‐75% ), total lung capacity (TLC), diffusion capacity corrected for hemoglobin (DLCO corr ), RV, FRC, and RV/TLC. Older age at the time of allo‐HSCT was associated with lower FEV 1 /FVC, FEF 25%‐75% , and DLCO corr and higher RV/TLC. Patients who experienced respiratory events within 1 year post–allo‐HSCT had lower FEV 1 and FVC values and higher RV/TLC from their baseline pulmonary function tests. Female patients had reduced FVC, TLC, and RV values but higher FEV 1 /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.