PULMONARY COMPLICATIONS AND RESPIRATORY-FUNCTION CHANGES AFTER BONE-MARROW TRANSPLANTATION IN CHILDREN

We prospectively assessed the frequency of pulmonary complications and the natural course of lung function after bone marrow transplantation (BMT), as well as the effect of several risk factors in a homogeneous group of 39 children who underwent allogeneic or autologous BMT for h aematological malignancies between 1992 and 1995, Four patients develo ped pneumonia within the first 3 months and three 3-6 months after BMT , A considerable percentage of acute bronchitis was recorded throughou t the follow-up, Three patients died after the 6 month visit because o f pneumonia (two patients) and pulmonary aspergillosis (one patient), No patients had obstructive lung disease syndrome, At 3 months after B MT, forced vital capacity (FVC), forced expiratory volume in one secon d (FEV1) and transfer factor of the lung for carbon monoxide (TL,CO) s ignificantly decreased, but FEV1/FVC ratio and maximal expiratory flow at 25% of FVC remained unchanged, suggesting a restrictive defect wit h diffusion impairment. At 18 months, there was a progressive recovery in lung function, although only 11 patients had normalized, Seroposit ivity for cytomegalovirus had a significant effect on lung function wh ereas graft-versus-host disease also had an effect, although it was no t statistically significant, Baseline respiratory function, type of tr ansplant, type of conditioning regimen and respiratory infections did not significantly affect the outcome of BMT, The high frequency of sev ere lung function abnormalities found in this study, suggests a carefu l functional monitoring in all subjects undergoing bone marrow transpl antation, even in the absence of respiratory symptoms.