Lung function in survivors of childhood acute lymphoblastic leukemia

Study objectives: To evaluate lung function in patients cured from childhood acute lymphoblastic
leukemia (ALL) with chemotherapy alone or plus bone marrow transplantation (BMT). Pulmonary
toxicity is a well-recognized side effect of many ALL treatments.
Design: Cross-sectional study conducted at least 3 years after cessation of therapy.
Setting: Outpatient pneumology department of the University Hospital.
Patients: Forty-four subjects (age range at observation, 6 to 23 years): 21 treated only with
intensive Berlin-Frankfurt-Munster (BFM)-type chemotherapy for newly diagnosed ALL (group
A), and 23 treated with chemotherapy plus BMT (group B).
Measurements: A detailed history of smoking habit, respiratory symptoms, and diseases was
recorded directly from the patients with the aid of their parents. A complete physical examination
and lung function testing (lung volumes and diffusion capacity for carbon monoxide [DLCO]) were
performed in all subjects.
Results: No patient reported acute or chronic respiratory symptoms or diseases. In group A
patients, lung function was in the normal range, except for three subjects in whom there was an
isolated impairment of DLCO. In group B patients, lung function was markedly impaired, with
more than half the patients having an abnormal DLCO. A statistically significant difference was
found between the two groups for FVC (p 5 0.022) and DLCO (p 5 0.004).
Conclusions: Intensive, BFM-type frontline chemotherapy is not associated with late pulmonary
dysfunction; however, retreatment including BMT can frequently injure the lung. Thus, in
patients who undergo BMT and whose life expectancy is long, careful monitoring of lung function
and counseling about avoiding additional lung risk factors is recommended.