Abstract
Childhood cancer survivors treated with hematopoietic stem cell transplantation are at high risk for pulmonary morbidity and mortality. In this retrospective study we described transplant characteristics of pediatric patients who underwent hematopoietic stem cell transplantation in Switzerland and how these characteristics changed over time, compared self-reported pulmonary outcomes between transplanted and non-transplanted survivors, and investigated risk factors for the reported pulmonary outcomes. As part of the population-based Swiss Childhood Cancer Survivor Study, we sent questionnaires to all ≥5-year childhood cancer survivors diagnosed 1976–2010 at age ≤20 years. We included 132 transplanted survivors and 368 matched non-transplanted survivors. During the study period transplant characteristics changed, with decreasing use of total body irradiation and increased use of peripheral blood stem cells and mismatched and unrelated donors as transplant source. One-fifth of transplanted survivors (20%, 95%CI 13–27%) and 18% of non-transplanted survivors (95%CI 13–21%) reported at least one pulmonary outcome. None of the analyzed factors was significantly associated with an increased risk of pulmonary outcomes in multivariable analysis. We found that pulmonary outcomes were frequently reported in transplanted and non-transplanted childhood cancer survivors, indicating a strong need for long-term pulmonary follow-up care.
Highlights
Childhood cancer survivors treated with hematopoietic stem cell transplantation are at high risk for pulmonary morbidity and mortality
All except one cancer survivors (CCS) have been transplanted autologous, most suffered from relapsed disease (n = 10), received radiotherapy to the chest (n = 10), were treated with open thoracic surgeries (n = 9), received at least one lung toxic chemotherapeutic agent (n = 7), or have been exposed to a combination of radiotherapy and thoracic surgery or resection of lung tissue (n = 9) (Supplementary Table S5). This nationwide population-based cohort study found that transplant characteristics changed over time with fewer Hematopoietic stem cell transplantation (HSCT) recipients receiving total body irradiation (TBI) or lung toxic chemotherapeutics
Even though TBI cannot completely be replaced by chemotherapy, such as in acute lymphoblastic leukemia [33], we found that the use of TBI has become less common in more recent eras
Summary
Childhood cancer survivors treated with hematopoietic stem cell transplantation are at high risk for pulmonary morbidity and mortality. In this retrospective study we described transplant characteristics of pediatric patients who underwent hematopoietic stem cell transplantation in Switzerland and how these characteristics changed over time, compared self-reported pulmonary outcomes between transplanted and non-transplanted survivors, and investigated risk factors for the reported pulmonary outcomes. During the study period transplant characteristics changed, with decreasing use of total body irradiation and increased use of peripheral blood stem cells and mismatched and unrelated donors as transplant source. One-fifth of transplanted survivors (20%, 95%CI 13–27%) and 18% of non-transplanted survivors (95%CI 13–21%) reported at least one pulmonary outcome. We found that pulmonary outcomes were frequently reported in transplanted and nontransplanted childhood cancer survivors, indicating a strong need for long-term pulmonary follow-up care
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