LUNG-FUNCTION AND EXERCISE CAPACITY IN SURVIVORS OF CHILDHOOD LEUKEMIA

The survival from acute lymphoblastic leukaemia in childhood is now ap proximately 60-70%, and from acute myeloid leukaemia, up to 50%. Howev er, there is little information on the effects of intensive chemothera py and radiotherapy used in the treatment of these conditions on lung function and exercise capacity in the long term. Seventy survivors of acute leukaemia from one centre in the UK were studied. Measurements o f lung volumes, spirometry and transfer factor were made. Each child a lso performed a standard, symptom-limited maximal exercise test on a c ycle ergometer. Predictive equations for indices of lung function and exercise tolerance were calculated from 146 age- and sex-matched contr ol subjects. The results of the survivors of leukaemia were compared t o these. There was a significant reduction of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), total lung capacit y (TLC), and transfer for carbon monoxide (DLCO; P < 0.05 for each mea surement), in the survivors of leukaemia when compared to the control subjects. In addition, there was a mild but significant reduction of b oth maximal and submaximal indices of: exercise capacity in the leukae mic group. A multivariate analysis was carried out to identify those v ariables acting independently to reduce lung volumes. For FEV1, FVC an d TLC, these were craniospinal irradiation, cyclophosphamide and chest complications during treatment. For a reduction in DLCO, the signific ant factors were administration of anthracyclines, craniospinal irradi ation and bone marrow transplantation. Survivors of acute leukemia hav e impaired pulmonary function and exercise capacity. Long-term cardiop ulmonary follow-up may be necessary and new regimens devised which red uce long-term toxicity without compromising survival rates. (C) 1995 W iley-Liss, Inc.