Language

English

Publication Date

10-1-2025

Journal

Pediatric Blood & Cancer

DOI

10.1002/pbc.31916

PMID

40692216

PMCID

PMC12879546

PubMedCentral® Posted Date

2-7-2026

PubMedCentral® Full Text Version

Author MSS

Abstract

Background: Pulmonary complications are a major cause of morbidity and mortality in pediatric and young adult hematopoietic stem cell transplant (HSCT) recipients. The impact of preexisting lung dysfunction on posttransplant outcomes remains understudied.

Methods: In a multi-institutional prospective cohort of 444 patients (≤24 years) undergoing allogeneic HSCT at eight centers, baseline lung function was categorized as normal or abnormal using clinical history, imaging, pulmonary function tests (PFTs), and pulmonologist review. Spirometry and diffusion capacity were assessed at baseline, Day 100, 1 year, and 2 years post-HSCT.

Results: Baseline pulmonary dysfunction was present in 224 patients (50.4%), including impaired spirometry (46.4%), low diffusion capacity (33.8%), and imaging abnormalities (e.g., nodules 19%, interstitial changes 7.9%). These patients had significantly lower median z-scores for forced expiratory volume in 1 s (FEV1) (-2.3 vs. -0.5), forced vital capacity (FVC) (-2.0 vs. -0.3), and diffusion capacity of the lung for carbon monoxide (-2.4 vs. -0.7; all p < 0.001). Lung function impairments persisted through 2 years post-HSCT. FEV1 and FVC remained significantly lower at all time points; FEV1/FVC ratios were similar. Overall survival was lower in the abnormal group (88.4 vs. 95.9%). Seven respiratory-related deaths occurred, including acute respiratory distress syndrome (n = 3), respiratory failure (n = 2), diffuse alveolar hemorrhage (n = 1), and fibrotic lung disease (n = 1).

Conclusions: Pretransplant pulmonary dysfunction is common and predicts sustained posttransplant impairment and lower survival. Comprehensive baseline assessment may aid in risk stratification and guide early interventions to improve long-term respiratory outcomes in pediatric and young adult HSCT patients.

Keywords

Adolescent, Adult, Child, Child, Preschool, Female, Humans, Infant, Male, Young Adult, Follow-Up Studies, Hematopoietic Stem Cell Transplantation, Lung Diseases, Prevalence, Prognosis, Prospective Studies, Respiratory Function Tests, Survival Rate, allogeneic stem cell transplant, pediatric, pulmonary dysfunction, PFT

Comments

Clinical Trials Identifier: NCT04098445.

Published Open-Access

yes

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.