Birgitta Versluijs

Genetic predisposition Atopy Innate immunity Pulmonary condition prior to cancer treatment Chemotherapy  Bleomycin  Busulfan  Cyclophosphamide  Nitrosureas Radiation  Chest  TBI  Scattering Surgery Alloimmunity  IPS/BO Other late effects of cancer treatment  Chest wall deformity  Growth retardation  Cardiac dysfunction  Obesity  Muscle weakness Occupational hazards Pollution Smoking Infections 33 Pulmonary complications of childhood cancer treatment weakness may contribute to restrictive lung disease. 38,43 Obstructive lung disease is seen in 8-19% of survivors of paediatric HCT. 38,43 The most common form of obstructive lung disease after HCT is Bronchiolitis Obliterans. With longer follow up time PFTs show steady decline up to 10 years after treatment. 44 Other factors influencing lung function in childhood cancer survivors It is important to emphasize that apart from lung damage due to treatment, several other factors play an important role in pulmonary function abnormalities in survivors of child- hood cancer. Recurrent infections during treatment and long after, impaired growth, chest wall abnormalities, muscle weakness, obesity, cardiac function and lifestyle issues (smoking habits) are among those (see Figure 4). FIGURE 4. Overview of pulmonary complications of childhood cancer treatment on long term followup. TBI, Total Body Irradiation; IPS, Idiopathic Pneumonia Syndrome; BO, Bron- chiolitis Obliterans; SOB, shortness of breath.  Abnormal  pulmonary  function test  obstructive  restrictive  Symptoms  cough  exertional SOB  dyspnea at rest  supplemental  oxygen  Morbidity  lung fibrosis  bronchiolitis  obliterans  lung cancer?  Mortality  end stage  lung disease  pneumonia Childhood cancer Ageing Growing child Lung development until age 8 yr 2