Study objectives: To evaluate early and late lung
function abnormalities and their predictors in a large sample of
children who underwent bone marrow transplantation (BMT) for leukemias
in the 1990s, highlighting changes with respect to the 1980s.
Designs: Prospective cohort.
university department of pediatrics.
Seventy-five consecutive children who underwent BMT were enrolled in
the study (median age, 11 years; range, 6 to 19 years; 45 male and 30
female children). Twenty-three children received autologous BMT, and 52
children received allogeneic BMT; 50 children completed the study.
Measurements: Clinical examinations and lung function tests
were performed before BMT, and 3 to 6 months, 12 months, and 24 months
Results: Before BMT, at 3 to 6 months after
BMT, and at 24 months after BMT, 44%, 85%, and 62% of children,
respectively, had altered lung function in the absence of persistent
respiratory symptoms. Between 3 months and 6 months after BMT, a
restrictive pattern was the most frequent abnormality. The only
predictive factors for late abnormalities were transplantation
performed in the advanced disease phase (odds ratio [OR], 6.75;
p = 0.005) and bronchopulmonary infections (OR, 3.9;
p < 0.05).
Conclusions: These data suggest
that a significant proportion of children who undergo BMT, especially
if for leukemia in advanced phase, have early and late pulmonary
abnormalities. These abnormalities, especially the late ones, seem to
be more severe than patients reported in studies analyzing children
undergoing BMT in the 1980s. This could be due to the more intensive
front-line treatment protocols employed for treatment of children with
acute leukemia in the 1990s.