Long-term morbidity of respiratory viral infections during chemotherapy in children with leukaemia.

Abstract

BACKGROUND:

Respiratory viruses are a common cause of infection in immunosuppressed children undergoing cancer therapy. Pulmonary sequelae have been documented following respiratory viral infections (RVIs) in hematopoietic stem cell transplant (HSCT) recipients; however potential late effects in children undergoing nonmyeloablative chemotherapy have not been investigated.

AIM:

To evaluate the long-term pulmonary morbidity of respiratory viral infections during chemotherapy in children with acute lymphoblastic leukemia (ALL).

METHODS:

Childhood ALL survivors, aged 7 to 18 years, greater than 6 months posttreatment were recruited. Exclusion criteria included HSCT or proven bacterial/fungal respiratory infection during treatment. Subjects were classified into "viral" or "control" groups according to retrospective medical records that documented the presence of laboratory-proven RVIs during chemotherapy. Symptom questionnaires (Liverpool, ISAAC) and lung function testing (spirometry, plethysmography, diffusing capacity, forced oscillation technique to ATS/ERS standards) were then performed cross-sectionally at the time of recruitment.

RESULTS:

Fifty-four patients (31 viral, 23 control) were recruited: median (range) age 11.2 (7.2-18.1) years, and at 4.9 (0.5-13) years posttherapy. Abnormalities were detected in 17 (31%) individuals (8 viral, 9 control), with the most common being DLCO impairment (3 viral, 4 control) and reduced respiratory reactance at 5 Hz (5 viral, 6 control). Children with RVIs during chemotherapy reported more current respiratory symptoms, particularly wheeze (odds ratio [OR], 3.0; 95% confidence interval [CI]: 0.9-10.0; P = .09) and cough (OR, 2.7; 95% CI: 0.8-9.5; P = .11). No differences in lung function tests were observed between the two groups.

CONCLUSIONS:

Our study found children with RVIs during chemotherapy developed more long-term respiratory symptoms than controls; however, differences did not reach statistical significance. No differences in static lung function were found between the two groups. Overall, pulmonary abnormalities and/or significant ongoing respiratory symptoms were detected in nearly a third of ALL survivors treated without HSCT. Larger, prospective studies are warranted to evaluate the etiology and clinical significance of these findings.

• Authors: Beryl Lin, Brendan Kennedy, Jamie McBride, Luciano Dalla-Pozza, Toby Trahair, Geoffrey McCowage, Emma Coward, Leanne Plush, Paul D Robinson, Kate Hardaker, John Widger, Anthea Ng, Adam Jaffe, Hiran Selvadurai
• Journal: Pediatric pulmonology (Pediatr Pulmonol) Vol. 54 Issue 11 Pg. 1821-1829 (11 2019) ISSN: 1099-0496 [Electronic] United States
• PMID: 31393087 (Publication Type: Journal Article)
• Copyright: © 2019 Wiley Periodicals, Inc.

Chemical References

• Antineoplastic Agents

Topics

• Adolescent
• Antineoplastic Agents (therapeutic use)
• Child
• Cross-Sectional Studies
• Female
• Humans
• Male
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (drug therapy, epidemiology, physiopathology)
• Respiratory Function Tests
• Respiratory Tract Infections (epidemiology, physiopathology)
• Retrospective Studies
• Virus Diseases (epidemiology, physiopathology)