title: High Diagnostic Yield of Dedicated Pulmonary Screening before Hematopoietic Cell Transplantation in Children.
abstract: Pulmonary complications are an important cause for treatment-related morbidity and mortality in hematopoietic cell transplantation (HCT) in children. The aim of this study was to investigate the yield of our pre-HCT pulmonary screening program. We also describe our management guidelines based on these findings and correlate them with symptomatic lung injury after HCT. Since 2008, all patients undergo a dedicated pulmonary screening consisting of pulmonary function test (PFT), chest high-resolution computed tomography (HRCT), and bronchial alveolar lavage (BAL) before HCT. We systematically evaluated the yield during the first 5 years of our screening program. We included 142 consecutive children. In 74% of patients, abnormalities were found. In 66% of patients, 1 or more PFT results were <80% of normal. Chest HRCT showed abnormalities in 55%; 19% of these abnormalities were considered "clinically significant." BAL was abnormal in 43% of patients; respiratory viruses (PCR) were found in 35 patients, fungi (antigen or culture) in 21, and bacteria (culture) in 22. All 3 screening tests contributed separately to clinically relevant information regarding pulmonary status in these pre-HCT children. In 46 patients (33%), screening results had diagnostic and/or therapeutic implications. We found an association between pre-SCT HRCT findings and lung injury after transplantation. Pre-HCT screening with the combination of 3 modalities, reflecting different domains of respiratory status (function, structure, and microbial colonization), reveals important abnormalities in a substantial number of patients. Whether this improves patient outcome requires further investigation.
authors.affiliation: Paediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands. Electronic address: a.b.versluys@umcutrecht.nl.
authors.forename: Anne Birgitta
authors.initials: AB
authors.lastname: Versluys
authors.affiliation: Department of Paediatric Pulmonology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Korstiaan
authors.initials: K
authors.lastname: van der Ent
authors.affiliation: Paediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Boelens
authors.affiliation: Department of Paediatric Infectious Diseases, University Medical Center/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Wolfs
authors.affiliation: Department of Radiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: de Jong
authors.affiliation: Paediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Marc B
authors.initials: MB
authors.lastname: Bierings
mesh_terms: D000293:Adolescent; D000328:Adult; D018893:Bronchoalveolar Lavage; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D055370:Lung Injury / Q000000981:diagnostic imaging / Q000378:metabolism; D008297:Male; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed
keywords: Pulmonary complications; Pulmonary function test; Respiratory viruses; Screening