Pulmonary Complications of Malignancies and Blood and Marrow Transplantation

Advances in childhood cancer therapies and blood and marrow transplantation (BMT) have dramatically improved survival in the past decade, with 5-year survival now approaching 85% (Australian Institute of Health and Welfare, Cancer in Australia: an overview 2014. Cancer series no 90 Cat no CAN 88 Canberra, AIHW2014). Pulmonary complications however remain an important cause of short- and long-term morbidity and mortality in childhood malignancies (Meyer et al., Pediatr Hematol Oncol 21(2):175–195, 2004; Jenney, Paediatr Respir Rev 1(3):279–286, 2000). The development of acute respiratory complications should prompt consideration of a wide range of differentials as appropriate management can be a major predictor of survival, especially in children undergoing BMT (Meyer et al., Pediatr Hematol Oncol 21(2):175–195, 2004; McCahon, Paediatr Respir Rev 7(3):191–196, 2006; Krowka et al., Chest 87(2):237–246, 1985). In childhood cancer survivors, permanent and late-onset respiratory dysfunction have been found in up to 45% of patients and continue to have important impacts on quality of life and premature mortality (Mertens et al., Cancer 95(11):2431–2441, 2002; Versluys and Bresters, Paediatr Respir Rev 17:63–70, 2015; Huang et al., Chest 140(4):881–901, 2011; Mulder et al., Thorax 66(12):1065–1071, 2011). This chapter provides an overview of respiratory complications of childhood cancer and BMT, with a focus on mechanisms of injury.