Skip to content
My WebMD Sign In, Sign Up

Cancer Health Center

Font Size

Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Health Professional Information [NCI] - Late Effects of the Respiratory System

continued...

Patients undergoing hematopoietic stem cell transplant (HSCT) are at increased risk of pulmonary toxicity, related to (1) preexisting pulmonary dysfunction (e.g., asthma, pretransplant therapy); (2) the preparative regimen that may include cyclophosphamide, busulfan, and carmustine; (3) total-body irradiation; and (4) the presence of GVHD.[12,13,14,15,16,17] Although most survivors of transplant are not clinically compromised, restrictive lung disease may occur and has been reported to increase in prevalence with increasing time from HSCT, based on limited data from longitudinally followed cohorts.[18,19] Obstructive disease is less common, as is late onset pulmonary syndrome, which includes the spectrum of restrictive and obstructive disease. Bronchiolitis obliterans with or without organizing pneumonia, diffuse alveolar damage, and interstitial pneumonia may occur as a component of this syndrome, generally between 6 and 12 months posttransplant. Cough, dyspnea, or wheezing may occur with either normal chest x-ray or diffuse/patchy infiltrates; however, most patients are symptom free.[14,20,21,22]

Additional factors contributing to chronic pulmonary toxicity include superimposed infection, underlying pneumonopathy (e.g., asthma), cigarette use, respiratory toxicity, chronic GVHD, and the effects of chronic pulmonary involvement by tumor or reaction to tumor. Lung lobectomy during childhood appears to have no significant impact on long-term pulmonary function,[23] but the long-term effect of lung surgery for children with cancer is not well defined.

The true prevalence or incidence of pulmonary dysfunction in childhood cancer survivors is not clear. For children treated with HSCT, there is significant clinical disease. No large cohort studies have been performed with clinical evaluations coupled with functional and quality of life assessments. An analysis of self-reported pulmonary complications of 12,390 survivors of common childhood malignancies has been reported by the Childhood Cancer Survivor Study.[24] This cohort includes children treated with both conventional and myeloablative therapies. Compared with siblings, survivors had an increased relative risk (RR) of lung fibrosis, recurrent pneumonia, chronic cough, pleurisy, use of supplemental oxygen therapy, abnormal chest wall, exercise-induced shortness of breath, and bronchitis, with RRs ranging from 1.2 to 13.0 (highest for lung fibrosis and lowest for bronchitis). The 25-year cumulative incidence of lung fibrosis was 5% for those who received chest radiation therapy and less than 1% for those who received pulmonary toxic chemotherapy. With changes in the doses of radiation therapy employed since the late 1980s, the incidence of these abnormalities is likely to decrease.

Table 14. Pulmonary Late Effects

Predisposing TherapyPulmonary EffectsHealth Screening/Interventions
DLCO = diffusing capacity of the lung for carbon monoxide; GVHD = graft-versus-host disease.
Busulfan; carmustine (BCNU)/lomustine (CCNU); bleomycin; radiation impacting lungs; surgery impacting pulmonary function (lobectomy, metastasectomy, wedge resection)Subclinical pulmonary dysfunction; interstitial pneumonitis; pulmonary fibrosis; restrictive lung disease; obstructive lung diseaseHistory: cough, shortness of breath, dyspnea on exertion, wheezing
Pulmonary exam
Pulmonary function tests (including DLCO and spirometry)
Chest x-ray
Counsel regarding tobacco avoidance/smoking cessation
In patients with abnormal pulmonary function tests and/or chest x-ray, consider repeat evaluation prior to general anesthesia
Pulmonary consultation for patients with symptomatic pulmonary dysfunction
Influenza and pneumococcal vaccinations
Hematopoietic cell transplantation with any history of chronic GVHDPulmonary toxicity (bronchiolitis obliterans, chronic bronchitis, bronchiectasis)History: cough, shortness of breath, dyspnea on exertion, wheezing
Pulmonary exam
Pulmonary function tests (including DLCO and spirometry)
Chest x-ray
Counsel regarding tobacco avoidance/smoking cessation
In patients with abnormal pulmonary function tests and/or chest x-ray, consider repeat evaluation prior to general anesthesia
Pulmonary consultation for patients with symptomatic pulmonary dysfunction
Influenza and pneumococcal vaccinations
1|2|3

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
Next Article:

Today on WebMD

Building a Support System
Blog
cancer fighting foods
SLIDESHOW
 
precancerous lesions slideshow
SLIDESHOW
quit smoking tips
SLIDESHOW
 
Jennifer Goodman Linn self-portrait
Blog
what is your cancer risk
HEALTH CHECK
 
colorectal cancer treatment advances
Video
breast cancer overview slideshow
SLIDESHOW
 
prostate cancer overview
SLIDESHOW
lung cancer overview slideshow
SLIDESHOW
 
ovarian cancer overview slideshow
SLIDESHOW
Actor Michael Douglas
Article