Examination of the carbon monoxide diffusing capacity in children with oncohematological diseases after hematopoietic stem cell transplantation

The article presents the results of the study of the diffusion capacity of the lungs (DSL) for carbon monoxide by single inhalation (DLco) in children with acute leukemia (AL) and acquired idiopathic aplastic anemia (AIAA) after allogeneic hematopoietic stem cell transplantation (HSCT). A comparative analysis of the DLco indicator before the HSCT and on the 30th, 90th, 180th, 360th days after it was carried out. Its significant irreversible decrease was revealed starting from 30 days after HSCT during the year of follow-up in most patients with AL. In children with AIAA, a significant decrease in DSL was also registered after a month of follow-up, however, by a year of dynamic control, the changes were less pronounced than in AL group, and the average DLco value was restored to indicators before transplantation. This method is important to use in a comprehensive assessment of the functional state of the respiratory system for the timely diagnosis of pulmonary complications after HSCT.

1. Michelson, P.H., Goyal R., Kuriand G. Pulmonaly complications of haematopoietic cell transplantations in children / Pediatr Respir Rev – 2007; 8: 46–61.

2. Arbetter K. R. Prakash U. B., Tazelaar H. D., Douglas W.W. Radiation-induced pneumonitis in the «nonirradiated» lung. Mayo Clin. Proc.– 1999.74: 27–36

3. de Fijter W.M., Roumen R.M., Lybeert M.L., de Munck D.R., Luiten E.J. Pulmonary damage after radiotherapy for breast cancer. Ned. Tijdschr. Geneeskd.–1999. 143 (16): 833–836.

4. Berkey F.J. Managing the adverse effects of radiation therapy. Am Fam Phys.– 2010. 82:381–388, 394.

5. Massie M.J. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr.– 2004:57–71. Jereczek-Fossa B.A., Marsiglia H.R., Orecchia R. Radiotherapy-related fatigue. Crit Rev Oncol Hematol.– 2002. 41:317–25.

6. Adams M.J., Lipshultz S.E., Schwartz C., Fajardo L.F., Coen V., Constine L.S. Radiation-associated cardiovascular disease: Manifestations and management. Semin Radiat Oncol.– 2003.13:346–56.

7. Marks L.B., Carroll P.R., Dugan T.C., Anscher M.S. The response of the urinary bladder, urethra, and ureter to radiation and chemotherapy. Int J Radiat Oncol Biol Phys.– 1995. 31:1257–1280.

8. Semishcheva N.L., Karapetyan E.I., Maltseva T.A., Avdeeva N.V., Odireev A.N. Post-radiation pneumonitis in the practice of a pulmonologist // Bulletin – 2014–53: 137–142. (In Russ.).

9. Popova E.N. Drug-induced lung damage // Practical pulmonology – 2007. (In Russ.).

10. Gladilina I.A., Shabanov M.A., Kravets O.A., Zakhidova F.O., Ivanov S.M., Fedoseenko D.I. et al. Post-radiation lung damage / Oncology journal – 2020. 3 (2): 9–18. (In Russ.).

11. Kim J.H., Jenrow K.A., Brown S.L. Mechanisms of radiation-induced normal tissue toxicity and implications for future clinical trials. Radiat. Oncol.J.– 2014. 32:103–115.

12. Bentzen S.M. Preventing or reducing late side effects of radiation therapy: Radiology meets molecular pathology/ Nature Rev. Cancer – 2006. 6: 702–713.

13. Mikkelsen R.B., Wardman P. Biological chemistry of reactive oxygen and radiation-induced signal transduction mechanisms / Oncogene – 2003. 22: 5734–5754.

14. Fleckenstein K., Zgonjanin L. Temporal onset of hypoxia and oxidative stress after pulmonary irradiation. Int. J. Radiat. Oncol. Biol. Phys.– 2007. 68: 196–204.

15. Martin M. Lefaix J.L., Delanian S. TGF-β1 and radiations fibrosis: A master switch and specific therapeutic target? Int. J. Radiat. Oncol. Biol. Phys.– 2000. 47: 277–290.

16. Rubin R.L. Drug-induced lupus // Toxicology – 2005. 209(2):1245–59.

17. Danilenko A.A., Shakhtarina S.V. Early and late pulmonary complications of radiation therapy for Hodgkin’s lymphoma. // Pulmonology – 2013 (6): 92-98. (In Russ.).

18. Theuws J., Kwa S., Wagernaar A., Seppenwoolde Y., Boersma L.J., Damen E.M. et al. Predictors of overall pulmonary function loss in relation to 3-D dose distributions for patients with breast cancer and malignant lymphoma/ Radiother. Oncol.– 1998. 49: 233–243.

19. Grilli M.A. Pathophysiology of the lungs / Translated from English under the editorship of Yu.V. Natochin / M. BINOM.– 2005: 27–48. (In Russ.).

20. West D.B. Pathophysiology of the respiratory organs / Translated from English under the editorship of A.I. Sinopalnikov / M. BINOM – 2005: 44–48.

21. Savushkina O.I., Neklyudova G.V., Chernyak A.V. Theoretical, methodological and clinical aspects of the study of the diffusion capacity of the lungs. Bulletin – 2016. 59: 119–124. (In Russ.).

22. Wanger J., Clausen JL, Coates A., Pedersen O.F., Brusasco V., Burgos F. Standardisation of the measurement of lung volumes. Eur. Respir. J.– 2005; 26(3): 511–522.

23. Ogilvie C.M., Forster R.E., Blakemore W.S., Morton J.W. A standardized breath holding technique for the clinical measurement of the diffusing capacity of the lung for carbon monoxide. J. Clin. Invest. 1957; 36 (1, Pt 1): 1–17.

24. Graham B.L., Brusasco V., Burgos F, Cooper B.G., 4, Jensen R., Kendrick A. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur. Respir. J. 2017; 49 (1).

25. Neklyudova G.V., Chernyak A.V. Clinical significance of the study of the diffusion capacity of the lungs. Pulmonology and Allergology – 2013. 4: 54–59. (In Russ.).

26. Pellegrino R., Viegi G., Brusasco V., Crapo R.O., Burgos F., R Casaburi et al. Interpretative strategies for lung function tests. Eur. Respir. J.– 2005. 26 (5): 948–968.

27. Kudinova T.V., Skvortsova Yu.V., Bostanov D.E. Possibilities of pulse oscillometry in the diagnosis of lung function in children after allogeneic hematopoietic stem cell transplantation / Issues of hematology/oncology and immunopathology in pediatrics. 2022–21 (2): 140–145. (In Russ.).

28. MacIntyre N., Crapo R.O., Viegi G, Johnson D.C., C. P. M. van der Grinten, Brusasco V. et al. Standardization of the single-breath determination of carbon monoxide uptake in the lung. Eur. Respir. J.– 2005. 26(4): 720–735.

29. Johnson D.C. Importance of adjusting carbon monoxide diffusing capacity (DLCO) and carbon monoxide transfer coefficient (KCO) for alveolar volume. Resp.Med.J.– 1994. 1: 28–37.

30. Michael J., Hughes B., Neil B. Pride. Examination of the carbon monoxide diffusing capacity (DL(CO)) in relation to its KCO and VA components. Am.J. Respir. Crit. Care Med.– 2012. 186(2):132–139.