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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Leif Bjermer, Lund University, Sweden
- Second opponent: Professor Jon Andrew Hardie, University of Bergen
- Third member and chair of the evaluation committee: Associate Professor Mona-Elisabeth Rootwelt-Revheim, University of Oslo
Chair of the Defence
Professor Knut Stavem, University of Oslo
Principal Supervisor
Associate Professor Emerita May Brit Lund, University of Oslo
Summary
The number of young long-term survivors of severe hematological diseases is increasing, due to progress in treatment. However, multiagent chemotherapy regimens and allogeneic hematopoietic stem cell transplantation (allo-HSCT) may cause late adverse effects.
The aims of the PhD-project were to assess the extent and degree of late, treatment-related pulmonary effects in survivors treated early in life, and to identify risk factors for impairment in pulmonary function and cardiorespiratory fitness.
Two cohorts of survivors were studied: The first cohort had been treated for childhood acute lymphoblastic leukemia (ALL) with chemotherapy only and included 116 survivors, median 23 years after diagnosis. The second cohort included 103 survivors treated with allo-HSCT, median 17 years after diagnosis. 45% had received chemotherapy prior to allo-HSCT.
Mean pulmonary function and cardiorespiratory fitness level were within the lower limit of normal in both cohorts. In the ALL-cohort, 22% had impaired gas diffusing capacity, predominantly females, and 42% had impaired cardiorespiratory fitness. In the allo-HSCT cohort, 17% had impaired gas diffusing capacity, associated with chemotherapy prior to allo-HSCT. One-third had developed chronic graft-versus-host disease, of whom 40% had pulmonary involvement. Half of the survivors were overweight, and more than two-third were physically inactive in their daily life. Impaired cardiorespiratory fitness was found in 43%. Deconditioning and cardiopulmonary factors were equally common limitations to exercise.
Although the impairments were mainly subclinical, they may progress in the survivors’ further adulthood. Some survivors may need new treatment with potentially lung-toxic agents. Several of the survivors were overweight, physical inactive and many were smokers, which increase the risk for later disorders. Individually tailored follow-up of pulmonary function and targeted advice on modifiable lifestyle factors are recommended.
Additional information
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