Study objectives: To evaluate lung function in patients
cured from childhood acute lymphoblastic leukemia (ALL) with
chemotherapy alone or plus bone marrow transplantation (BMT). Pulmonary
toxicity is a well-recognized side effect of many ALL treatments.
Design: Cross-sectional study conducted at least 3 years
after cessation of therapy.
pneumology department of the University Hospital.
Patients: Forty-four subjects (age range at observation, 6
to 23 years): 21 treated only with intensive Berlin-Frankfurt-Munster
(BFM)-type chemotherapy for newly diagnosed ALL (group A), and 23
treated with chemotherapy plus BMT (group B).
Measurements: A detailed history of smoking habit,
respiratory symptoms, and diseases was recorded directly from the
patients with the aid of their parents. A complete physical examination
and lung function testing (lung volumes and diffusion capacity for
carbon monoxide [Dlco]) were performed in all
Results: No patient reported acute or
chronic respiratory symptoms or diseases. In group A patients, lung
function was in the normal range, except for three subjects in whom
there was an isolated impairment of Dlco. In group B
patients, lung function was markedly impaired, with more than half the
patients having an abnormal Dlco. A statistically
significant difference was found between the two groups for FVC
(p = 0.022) and Dlco (p = 0.004).
Conclusions: Intensive, BFM-type frontline chemotherapy is
not associated with late pulmonary dysfunction; however, retreatment
including BMT can frequently injure the lung. Thus, in patients who
undergo BMT and whose life expectancy is long, careful monitoring of
lung function and counseling about avoiding additional lung risk
factors is recommended.