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

Cancer. 2010 Apr 15;116(8):2020-30. doi: 10.1002/cncr.24897.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Female
  • Hematologic Neoplasms / physiopathology*
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Lung / physiopathology*
  • Lung Diseases / epidemiology
  • Lung Diseases / etiology
  • Male
  • Prospective Studies
  • Respiratory Function Tests
  • Respiratory Physiological Phenomena
  • Risk Factors
  • Survivors
  • Transplantation, Homologous