Airway Reactivity in Children Before and After BMT Bone Marrow Transplantation
Condition: Cancer
Study type: Observational

Summary: 
      Background: Stem cell transplantation (SCT) is associated with pulmonary complications and
      may lead to high morbidity and mortality. We encountered several children post-SCT with a
      clinical picture suggestive of airway hyper-reactivity (AHR) and evidence of reversible
      airway obstruction that was not reported pre-transplant. Our aim was to determine if SCT
      induced AHR as assessed by methacholine challenge test (MCT) and to determine any correlation
      between AHR and pulmonary complications.

      Methods: Prospective study evaluating consecutive patients referred for SCT to the Department
      of Pediatric Hemato-Oncology at Meyer Children's Hospital. Evaluation included pulmonary
      function test and methacholine challenge test before and after the transplantation, and
      assessment of pulmonary complications.
    

Detailed description: 
      We encountered several children post SCT with clinical picture suggestive of airway
      hyper-reactivity (AHR) by spirometric evidence of reversible airway obstruction that was not
      reported pre transplantation. Our question was if AHR is present but undiagnosed pre BMT or
      AHR is developed post transplantation.

      Our aim was to determine if BMT induces AHR as assessed by methacholine challenge test (MCT)
      and to determine a possible correlation between AHR and pulmonary complications. The study
      was Prospective. Subjects: consecutive patients were referred for pulmonary function tests
      (PFT's); MCT and clincical evaluation before SCT and were followed after transplantation for
      at least a year. The study was approved by the ethics committee and parental consent was
      obtained. Clnical evaluation included medical history: type of disease, previous
      chemo/radiotherapy. Type of SCT was recorded (allogeneic/ autologous). respiratory evaluation
      included: Respiratory history; previous asthma medications; allergy/ parental smoking;
      Physical exam; CXR O2-Sat. on rest and exercise. PFT's included: Spirometry, lung volumes,
      diffusion capacity; MCT prior and 2-6 months post SCT; Follow-up: 6-12 months post SCT.
      Pulmonary complication: Any respiratory symptoms or signs: cough, SOB, hemoptysis, hypoxemia;
      New chest radiological finding; Number of hospitalizations due to pulmonary complications.

      Statistics: Sample size-26 patients to detect an increase of 0.5SD in AHR with a power of
      80%. No. of children with AHR before and after SCT.; Pulmonary complications and AHR:
      hospitalizations for pulmonary complications and AHR.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Children who underwent SCT in the Department of Pediatric Hemato-Oncology at Meyer
        Children's Hospital and were referred to the Pediatric Pulmonary Unit.
      
Biospecimen description: 
      Not retained
    
Keywords: Stem cell transplantation; Airway hyper-reactivity; methacholine; pediatric