{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:56:17Z","timestamp":1793386577557,"version":"4.5.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swiss Cancer Research and Swiss Cancer League","award":["KFS-5027-02-2020"],"award-info":[{"award-number":["KFS-5027-02-2020"]}],"id":[{"id":"https:\/\/ror.org\/01pd7my79","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Swiss Cancer Research and Swiss Cancer League","award":["KFS-5302-02-2021"],"award-info":[{"award-number":["KFS-5302-02-2021"]}],"id":[{"id":"https:\/\/ror.org\/01pd7my79","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Swiss Cancer Research and Swiss Cancer League","award":["KLS\/KFS-5711-01-2022"],"award-info":[{"award-number":["KLS\/KFS-5711-01-2022"]}],"id":[{"id":"https:\/\/ror.org\/01pd7my79","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Swiss Cancer Research and Swiss Cancer League","award":["KFS-6096-02-2024"],"award-info":[{"award-number":["KFS-6096-02-2024"]}],"id":[{"id":"https:\/\/ror.org\/01pd7my79","id-type":"ROR","asserted-by":"crossref"}]},{"name":"CANSEARCH Research Foundation, and the Association Jurassienne d\u2019Aide aux Familles d\u2019Enfants atteints de Cancer"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Childhood cancer survivors (CCS) are at risk for long-term pulmonary complications from treatment-related toxicity. Nitrogen multiple breath washout (N2MBW) may detect small airway dysfunction earlier than standard pulmonary function tests (PFTs), but its value in CCS remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the prevalence of ventilation inhomogeneity measured by N2MBW in CCS, evaluate whether it detects abnormalities beyond spirometry and diffusion capacity for carbon monoxide (DlCO), and explore associations with treatment exposures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective multicenter study (Bern, Basel, and Geneva, Switzerland), we measured lung function in CCS aged 6 to 21\u2009years who were undergoing routine follow-up. We stratified participants into high-risk (pulmotoxic chemotherapy [busulfan, bleomycin, nitrosoureas], thoracic surgery, radiotherapy, or hematopoietic stem cell transplantation [HSCT]) and standard-risk (other systemic anticancer treatments). PFTs included N2MBW (lung clearance index [LCI], acinar [SACIN] and conductive [SCOND] inhomogeneity), spirometry (forced expiratory volume in 1\u2009second [FEV1], forced vital capacity [FVC]), and DlCO. Abnormal values were defined as z-score &amp;lt;\u2009\u22121.645 or &amp;gt;1.645, calculated using the Global Lung Initiative references. We quantified the proportion of participants with isolated elevated LCI and analyzed associations with treatment exposures using multivariable linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 191 CCS (median 7\u2009years postdiagnosis). Mean LCI was 6.27 (95% CI, 6.17-6.37), with 7% of participants showing abnormal values. N2MBW results did not differ between high- and standard-risk groups, but allogeneic HSCT survivors had the highest mean LCI (7.18 [95% CI, 5.99-8.38]), with 33% abnormal. Survivors had mildly impaired mean FEV1, FVC, and DlCO z-scores (\u22120.21, \u22120.34, 0.23), more pronounced in high-risk CCS (\u22120.67, \u22120.85, \u22120.05). Isolated LCI impairment, without abnormalities in spirometry or DlCO, occurred in only 3%. Among treatment exposures, only allogeneic HSCT was associated with higher LCI (1.40 [95% CI, 0.57-2.33]) and SACIN (1.24 [95% CI, 0.20-2.28]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most pediatric CCS had normal lung function. N2MBW abnormalities were rare, occurring mainly in allogeneic HSCT survivors. Overall, N2MBW added little beyond standard PFTs, suggesting it may not be needed for routine follow-up at this stage, except after allogeneic HSCT. Larger, longitudinal studies should clarify the onset, progression, and prognostic significance of N2MBW abnormalities and their potential role in risk-adapted follow-up care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>NCT04732273.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag113","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:04:08Z","timestamp":1777439048000},"page":"1696-1705","source":"Crossref","is-referenced-by-count":2,"title":["Multiple breath washout for pulmonary function assessment in young childhood cancer survivors: a\u00a0multicenter study"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0220-5566","authenticated-orcid":false,"given":"Ma\u0161a","family":"\u017darkovi\u0107","sequence":"first","affiliation":[{"name":"Childhood Cancer 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Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9649-6498","authenticated-orcid":false,"given":"Marc","family":"Ansari","sequence":"additional","affiliation":[{"name":"CANSEARCH Research Platform for Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva , Geneva,","place":["Switzerland"]},{"name":"Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva , Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5239-1571","authenticated-orcid":false,"given":"Philipp","family":"Latzin","sequence":"additional","affiliation":[{"name":"Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern , 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