Late pulmonary sequelae after childhood bone marrow transplantation

Background-Respiratory function in transplanted children is important becau se of the long life expectancy of bone marrow transplant recipients, partic ularly children. Attention is now being focused on the late sequelae of tre atment on organ system function. A few papers have been published but avail able data are somewhat conflicting. Methods-A cross sectional study aimed at evaluating the late effects of tra nsplantation on lung function was performed in a group of 52 young patients who were given autologous or allogeneic bone marrow transplants during chi ldhood for haematological malignancies. Results-No patients reported chronic respiratory symptoms. The distribution of respiratory function patterns showed that only 62% of patients had resp iratory function within the normal limits; 23% had a restrictive pattern an d 15% had isolated transfer factor impairment. The percentage of patients w ith lung function abnormalities was higher in those who (1) received a bone marrow transplant after two or three complete remissions compared with tho se who were transplanted immediately after the first remission (54% vs 21%; p<0.02), (2) underwent allogeneic bone marrow transplantation rather than an autologous transplantation (45% vs 26%; p = 0.06), and (3) had a pulmona ry infection compared with those without (56% vs 26%; p = 0.07). Conclusions-In spite of the absence of chronic respiratory symptoms there i s a high prevalence of children with late pulmonary sequelae after bone mar row transplantation. Regular testing is recommended after transplantation, in particular in subjects at higher risk of lung injuries, such as those re ceiving transplants after more than one remission, those receiving allogene ic transplants, and those having suffered from pulmonary infections. When l ung function abnormalities become apparent, long term follow up is necessar y to see whether they become clinically relevant. All patients should remai n non-smokers after transplantation and should have active early and aggres sive treatment for respiratory illnesses.