Long term pulmonary side effects secondary to treatment in hodgkin lymphoma

Introduction: Hodgkin lymphoma is a malignancy with a high chance of survival with multimodal treatments, which accounts for 6% of childhood cancers. Today, many studies are being conducted in these patients for early diagnosis and preven-tion of late side effects due to treatment. Pulmonary late side effects are one of them. Bleomycin and mediastinal radiotherapy can be a risk factor for pulmonary late side effects. Objective: The most important method for detecting and monitoring pulmonary side effects is respiratory function tests. Respiratory functions of the patients can be evaluated with Spirometry, carbon monoxide diffusion capacity and lung cleansing index. In some studies, it has been reported that lung clearence index deteriorates earlier than spirometry and diffusion capacity in diseases affecting small airways. In this study, we also aimed to investigate whether late-stage pulmonary side effects were observed in patients treated for Hodgkin Lymphoma and whether the lung cle-arance index was superior to carbon monoxide diffusion capacity and spirometry in early detection and monitoring of pulmonary dysfunction in these patients. Materials and Methods: In our clinic, 35 patients who were treated with the diag-nosis of Hodgkin Lymphoma and were followed up after the treatment were inclu-ded in the study. The demographic features of the patients, disease stages, histologi-cal subgroups, and information about the treatments they received were obtained by retrospectively scanning the patients' files. Lung tomographies were evaluated. Spi-rometry, carbon monoxide diffusion capacity and lung cleansing index were used to examine pulmonary functions. The values of the patients were compared with the normal reference values and the limit values in the literature. The data were analy-zed statistically. Results: Twenty-four (68.6%) of the 35 patients who participated in the study were male, 11 (31.4%) were female and their age at the time of diagnosis was between 4-18 (median age: 13). At the time of diagnosis, 14 (40%) were at the early stage and 21 (60%) at the advanced stage. Force vital capacity value of advanced stage pa-tients was found to be significantly lower than early stage patients. Of the patients, 19 (54.3%) were nodular sclerosing, 14 (40%) mixed-cell and 2 (5.7%) nodular lymphocyte pre-dominant hodgkin lymphoma. There was no significant difference between the pulmonary function test results of these three histopathological sub-types. There were 16 patients (45%) with B symptoms and 19 patients (55%) with-out B symptoms. There was no significant difference in pulmonary function test results between patients with and without B symptoms. There was no significant difference in the pulmonary function test results between patients who received and did not receive mediastinal radiotherapy. No significant difference was found be-tween the respiratory functions of patients with a bleomycin cumulative dose of 60uu / m2 and below and patients over 60uu / m2. There was a statistically signifi-cant negative correlation between bleomycin cumulative dose and difficult vital capacity, and a statistically significant positive correlation between lung clearence index. Patients who had lung infection during treatment were significantly higher than those who did not have a lung cleansing index. In the spirometric results of the patients, restrictive changes were detected in 4 patients, 10 patients according to the diffusion capacity value, and 11 patients according to the total lung capacity value. There were no patients with obstructive changes. The mean lung cleansing index of the patients was 7.42 and this value was not compared to the study conducted on healthy children in our hospital. No significant difference was found between the patients with an abnormality in the results of spirometry and diffusion capacity and those with undetected pulmonary cleansing index values. Conclusion: In the follow-up of oncological patients, in addition to spirometry, dif-fusion capacity should be used in follow-up, but the lung clearing index has no sig-nificant superiority to other pulmonary function tests in determining lung dysfunc-tion. The cumulative dose of bleomycin and radiotherapy to mediastinum did not change the risk of pulmonary dysfunction in our patients. Keywords: Childhood Hodgkin Lymphoma, Lung clearence index, Pulmonary late side effects