OBSTRUCTIVE LUNG-DISEASE IN CHILDREN AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Obstructive lung disease (OLD) has been described as a significant com plication after allogeneic bone marrow transplantation (BMT). The inci dence of OLD in adults appears to be low (similar to 3%), but there is little data for children. We analyzed 89 consecutive pediatric alloge neic BMTs, greater than or equal to 1.5 years post-BMT, performed at B ritish Columbia's Children's Hospital from 1980 to 1992 for evidence o f OLD. Diagnosis of OLD was based on clinical findings (nonproductive cough, wheezing, and dyspnea with no evidence of infection), pulmonary function tests (FEV, < 80% and FEF(25-75%) < 60% predicted), lung bio psy, and computed tomography scan. Sixty-seven of the 89 children eval uated survived greater than or equal to 90 days and were classified as at risk for OLD. Thirteen of 67 (19.4%), developed OLD, 3 of which we re transient. The development of OLD was strongly associated with the following high-risk groups: chronic graft-versus-host disease (GVHD) ( 37.1% OLD), increased donor age, acute GVHD, and either mismatched rel ated or matched unrelated donor transplants. No correlation was found with methotrexate prophylaxis for GVHD, total body irradiation, or cyt omegalovirus reactivity in either donor or recipient and the developme nt of OLD. Further analysis of only children with chronic GVHD showed that liver involvement by GVHD before the onset of OLD (57.9%) was the only other significant predictive factor. We observed an overall incr eased prevalence of OLD in children compared with that previously repo rted in adults. Further studies are required to confirm whether age is a risk factor for development of OLD after allogeneic BMT. (C) 1994 b y The American Society of Hematology.