LONG-TERM PULMONARY SEQUELAE AFTER AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN CHILDREN WITHOUT TOTAL-BODY IRRADIATION

We investigated the long-term pulmonary sequelae of 38 children surviv ing 3 to 11.5 years (median 7 years) after high-dose chemotherapy (HDC ) and autologous bone marrow transplantation (ABMT) without TBI. This cross-sectional study included patients with neuroblastoma (21), non-H odgkin's lymphoma (7), Ewing's sarcoma (5), rhabdomyosarcoma (3), medu lloblastoma (1) and ALL (1). They were asked and examined for clinical signs and underwent a physical examination with chest X-ray; 33/38 ha d pulmonary function tests (PFT) performed. No obstructive disease was found. Fifteen out of 32 evaluable PFT (47%) were abnormal with a pul monary restrictive syndrome in 10, and borderline values in five patie nts. Four of these 15 patients were symptomatic with exertional dyspne a and two of four had abnormal chest X-rays. The etiology was mainly m ultifactorial, associating HDC with thoracic radiotherapy +/- scoliosi s/kyphosis +/- previous thoracotomy +/- post-ABMT interstitial pneumon itis. Only 3/10 patients with a restrictive syndrome had HDC containin g BCNU or busulfan as the only risk factor for lung disease. We conclu de that the prevalence of late pulmonary sequelae after ABMT without T BI is moderate and rarely due to HDC alone, since most abnormal PFT ca n be explained by heavy pretreatment prior to ABMT. As symptoms are sc arce even in advanced disease, repeated testing and very long-term fol low-up are needed.