in children after allogeneic bone marrow transplantation

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BMT at British Columbia's Children's Hospital (1980-1992) and the. Detroit Medical Center Bone M m w Transplantation (1986-1992) Pro- grams. The diagnosis ...
From bloodjournal.hematologylibrary.org by guest on July 16, 2011. For personal use only.

1995 85: 3763-3765

Association of gastroesophageal reflux with obstructive lung disease in children after allogeneic bone marrow transplantation [letter] KR Schultz, CV Fernandez, DM Israel, F Magee, D Wensley, MA Sargent, E Abella and C Karanes

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From bloodjournal.hematologylibrary.org by guest on July 16, 2011. For personal use only. CORRESPONDENCE

3763

Association of Gastroesophageal Reflux With Obstructive Lung Disease in Children After Allogeneic Bone Marrow Transplantation To the Editor: We recently rePofled a relatively high cumulative incidence (26.1 %) of obstructive lung disease (OLD) in children after allegeneic bone marrow transplantation (BMT).' OLD in these children, histologically consistent with bronchiolitis obliterans, may beassoci-

ated with severe respiratory insufficiency, leading to at death in least 30% of patients. Understanding factors that are associated with OLD in these children may contribute to improved therapy and survival. Gastroesophageal reflux (GER) in association with esophageal disease has been postulated as a cause of OLD in BMT patients.I.2 To test this hypothesis, we evaluated children with irreversible OLD for abnormal GER.

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3764

Table 1. Evaluation for Abnormal GER in Children With OLD After Allogeneic BMT Patient No. ~~

Vomiting pH

Probe

Endoscopic Findings

Esophageal Histology

Radiological GER Study

Manometry

Cause of Death

~

Abnormal GER Absent Absent Absent

Abnormal Abnormal Abnormal

Present Present Present Absent Absent

ND

9

Absent

ND

10 11

Absent Present

ND

1 2

3 4* 5

6 7

8 No GER

Abnormal ND ND

Abnormal

Normal

GE junction polyp ND

Esophagitis/ uIcerations/stricture Esophagitis Esophagitisfulcerations Esophagitis Esophageal stricture ND Stricture small intestine Normal Severe esophageal stricture

Esophagatis ND Esophagitis

ND ND ND

ND

Normal

Alive Relapse Respiratory failure

Esophagitis Esophagitis Esophagitis Esophagitis ND

Abnormal Abnormal Abnormal Abnormal Normal

ND ND ND ND ND

Respiratory failure Respiratory failure Respiratory failure Alive Alive

Normal

Abnormal

ND

Alive

Normal Normal

Normal ND

ND

Abnormal

Alive Alive

Normal

Abbreviation: ND, not done. * Patient had lipid laden macrophages on bronchial alveolar lavage.

Weidentified 15 childrenwithirreversibleOLDafterallogeneic 3 children without abnormal GER had strictures (1 small intestine BMT at British Columbia's Children's Hospital (1980-1992) and the and 1 esophagus) with normal histology at the time of testing. Ten ProDetroit Medical Center Bone M m w Transplantation (1986-1992) of 11 children studied were able to perform pulmonary function tests grams. The diagnosis of OLD was based oncriteriapreviouslyde(limited to children 25.0 years) and were evaluated at presentation scribed by our group.' Patientsdiagnosed as havingOLDshowed or within 12 months after diagnosis of OLD. Of these children, the no evidence of pulmonary abnormalities before transplantation. These mean FEV, was 40.3% predicted (95% confidence interval [CI], patients had at least one of the following findings, in the absence of 26.7 to 53.9) in abnormal GER patients compared with 53.6% (95% infection: (1) abnormal pulmonary function tests after transplant(FEV, CI, 20.5 to 86.7) in those without ( P = .15), and the mean FEF,,. 4 0 % predicted and FEFrr.7se