LONG-TERM PULMONARY SEQUELAE AFTER TREATMENT OF CHILDHOOD HODGKINS-DISEASE

Background: Pulmonary sequelae have been reported in patients treated for Hodgkin's disease (HD). Few data are available about patients trea ted for childhood HD followed over several years. Patients and methods . In a cross-sectional study carried out for 76 months (median time) a fter treatment completion, we evaluated the lung function abnormalitie s and respiratory symptoms in 27 patients (16 males and 11 females) wi th HD diagnosed betweeen 1983 and 1994 (median age at diagnosis 11 yea rs, range 2-16 years). They had been treated with chemotherapy and rad iotherapy according to current protocol AIEOP-MH 83 (n = 14) or AIEOP- MH 89 (n = 13). At the time of the study, 26 patients were in first co mplete remission and one in second remission. Of the 27 patients, 19 h ad had mediastinal irradiation at a dose of 20 Gy (n = 5) or 20.8-44 G y (n = 14). Forced vital capacity (FVC), functional residual capacity (FRC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, and maximal expiratory flow at 25% of FVC were registered; diffusion c apacity for carbon monoxide (DLCO) was determined. Data were expressed as standard deviation (SD) score. Four patterns of respiratory functi on abnormalities were defined: restrictive, obstructive, isolated bron chiolar impairment, isolated diffusing impairment. Results: Twelve pat ients (44%) were asymptomatic and showed completely normal pulmonary f unction tests. Three patients reported dyspnea on exertion, and one of them also cough and phlegm: out of these symptomatic subjects, only 1 had functional abnormality (isolated DLCO impairment). A restrictive pattern was found in 5 patients (18%), including 2 who also had a path ological DLCO SD score. Eight additional patients (30%) had isolated d iffusing impairment. Oxygen saturation was normal in all patients. For ty-seven percent of patients with normal DLCO had had lower dose irrad iation (20 Gy) compared to 10% of patients with impaired DLCO (P = 0.0 54). Similarly, patients with normal DLCO had had significantly less c hemotherapy as compared to patients with abnormal DLCO (P = 0.003). Oc currence of lung abnormalities was not significantly associated with s ex, age at treatment, mediastinal irradiation, and time elapsed from t reatment completion. Conclusion: Adolescents and young adults treated for childhood HD are at risk for lung function abnormalities, signific antly more frequent in patients who received more intense treatment, a s mediastinal irradiation at a higher dose (> 20 Gy) and more chemothe rapy blocks. Long-term follow-up should be offered to these patients b ecause of their possible limited potential for pulmonary function and possible lesser resistance to adverse agents such as smoke, pollution, infections, and aging.