Pediatric Pulmonary Rehabilitation after Hematopoietic Stem Cell Transplantation

Pulmonary complications are a cause of morbidity and mortality following hematopoietic stem cell transplant (HSCT) in children. Bronchiolitis obliterans syndrome (BOS) and lung graft versus host disease, a late-phase chronic respiratory complication of HSCT, contributes to decreased exercise tolerance and quality of life. Pulmonary rehabilitation (PR) has demonstrated efficacy in improving functional outcomes in adults with chronic respiratory disease, but pediatric-focused programs remain rare and under-investigated. The purpose of this study is to evaluate the characteristics and functional outcomes of pediatric patients with chronic respiratory disease after HSCT who enrolled in a comprehensive pediatric PR program. This single center, cohort study examined children with chronic respiratory disease after HSCT completing a comprehensive PR program. The study period was March 2017 to September 2025. Eligibility included completion of a baseline exercise evaluation and at least 5 PR sessions. Data were retrospectively abstracted from the electronic medical record, including demographics, reason for HSCT, type of transplant, pulmonary function tests (PFT), six-minute walk tests (6MWT), measures of exercise capacity, patient/caregiver reported quality of life outcomes, and patient/caregiver reported acceptability of the program. PFT outcomes included the forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) presented as z-scores. Data are presented as mean values with a standard deviation and includes comparisons pre- and post-PR. A total of 20 unique patients were enrolled in PR. The cohort included 9 males and 11 females. The mean age of participants at the start of PR enrollment was 15.5 years (SD 4.3). The mean time from HSCT to PR enrollment was 1,202 days (SD 1,372). The most common respiratory diagnosis at time of PR referral was BOS (N=13, 65%). The baseline lung function at PR enrollment was FEV1 z-score -3.82 (SD 1.29) and FVC z-score -2.80 (1.39). The 6MWT distance at PR enrollment was 1,289 feet (SD 361). Among participants with a paired post-PR 6MWT (N=18), distance walked increased to 1,469 feet (SD 441). Improvements were seen in other assessments of functional exercise performance (table 1). The PR program was favorably viewed by all the participating patients and caregivers (table 2). Children with chronic respiratory disease after HSCT improved their 6MWT distance and other measures of functional exercise performance and muscle strength following participation in a pediatric-specific PR program. Importantly, the participants and their caregivers had high satisfaction with the program, supporting its acceptability and feasibility. This data provides a foundation for future study on the impact of PR and exercise interventions on other clinical outcomes for patients after HSCT.