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Pediatric Transplants

Impact of cumulative anthracycline dose, preparative regimen and chronic graft-versus-host disease on pulmonary and cardiac function in children 5 years after allogeneic hematopoietic stem cell transplantation: a prospective evaluation on behalf of the EBMT Pediatric Diseases and Late Effects Working Parties

Bone Marrow Transplantation volume 39, pages 667–675 (2007)Cite this article

Abstract

This prospective study focused on risk factors and clinical outcome of pulmonary and cardiac late effects after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We prospectively evaluated 162 children by pulmonary function tests (PFTs) and cardiac shortening fraction (SF) before allo-HSCT and yearly up to the 5th year of follow-up. The 5-year cumulative incidence of lung and cardiac impairment was 35 (hazard rate=0.03) and 26% (hazard rate=0.06), respectively. Patients presenting abnormal PFTs and SF at last follow-up were 19 and 13%, respectively, with a median Lansky performance status of 90% (70–100). Chronic graft-versus-host disease (c-GVHD) was the major risk factor for reduced lung function in univariate (P=0.02) and multivariate analysis (P=0.02). Total body irradiation (TBI) alone and TBI together with pre-transplant anthracycline administration were significant risk factors for reduced cardiac function in univariate analysis, only (P=0.04 and 0.004, respectively). In conclusion, our prospective study demonstrates an asymptomatic post-allo-HSCT deterioration of pulmonary and cardiac function in some long-term survivors, who had been transplanted in childhood, and thus emphasizes the need for lifelong cardiopulmonary monitoring and the development of new strategies both to reduce pre-transplant cardiotoxic regimens and to treat more efficiently c-GVHD.

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Acknowledgements

The principal investigator is indebted to Professor Hans-Jochem Kolb (Munich) for his contribution in the early stage of the project and Joanna Upton for reviewing the paper. We would like to thank Dr Jakob Passweg (Basel) and Professor Maria Grazia Valsecchi (Monza) for their assistance in statistical analysis. This work was partially presented at the 47th Annual ASH meeting (Atlanta, USA, 10–13 December, 2005).

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Authors and Affiliations

  1. Centro Trapianti di Midollo Osseo, Clinica Pediatrica e, Ospedale San Gerardo di Monza Università di Milano Bicocca, Milano, Italy

    C Uderzo, P Corti, S Fedeli & A Rovelli

  2. Dipartimento di Pediatria, Clinica di Oncoematologia Pediatrica, Università di Padova, Padova, Italy

    M Pillon, G Tridello, S Varotto & C Messina

  3. Dipartimento Cardio-Toracico, Reparto di Pneumologia, Ospedale San Gerardo di Monza Università di Bicocca, Milano, Italy

    F Tana

  4. Department of Pediatrics, University of Jena, Jena, Germany

    F Zintl

  5. Section of Pediatric Hematology and Oncology, The J.M. Center, Copenhagen, Denmark

    K Nysom

  6. Service d'Hématologie Pédiatrique, Hôpital Debrousse, Lyon, France

    C Galambrun

  7. Dipartimento di Pediatria, Ospedale Regina Margherita, Università di Torino, Torino, Italy

    F Fagioli

  8. Oncologia Pediatrica, Hospital Infantil La Fe Valencia, Valencia, Spain

    A Verdeguer

  9. Division of Pediatric Hematology/Oncology, University Children's Hospital, Graz, Austria

    C Urban

  10. Dipartimento di Ematologia ed Oncologia, IRCCS ‘G. Gaslini’, Genova, Italy

    M Faraci & G Dini

  11. Department of Hematology, University Hospital, Basel, Switzerland

    A Tichelli

  12. Service d'Hématologie Greffe de Moelle, Hôpital Saint Louis, Paris, France

    G Socié

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  1. C Uderzo
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Correspondence to C Uderzo.

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Uderzo, C., Pillon, M., Corti, P. et al. Impact of cumulative anthracycline dose, preparative regimen and chronic graft-versus-host disease on pulmonary and cardiac function in children 5 years after allogeneic hematopoietic stem cell transplantation: a prospective evaluation on behalf of the EBMT Pediatric Diseases and Late Effects Working Parties. Bone Marrow Transplant 39, 667–675 (2007). https://doi.org/10.1038/sj.bmt.1705652

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