Birgitta Versluijs

174 Concluding remarks and future perspectives Currently a prospective study in both adults and children is done to identify new biomar- kers in BOS after HCT, which may lead to earlier identification of disease before FEV1% is reduced or clinical symptoms occur. Serial blood samples are taken every 3 months, and will be tested for neutrophil-, T cell-, fibrotic- and epithelium- biomarkers. Serial PFT are done as well. Endpoint of study is the development of BOS or the end of follow up at 3 years post HCT. Remarkably the incidence of BOS had decreased since we started the study, so we need more time for patient accrual to draw any conclusions. Currently 57 children are included, and only 2 of them have developed BOS. Concluding remarks and further perspectives Allo-LS after HCT is a life threatening complication. Respiratory Viruses play an impor- tant role by inducing tissue damage and triggering allo-immune mediated responses leading to severe lung disease. Identification of patients at risk for Allo-LS, general preventive strategies (isolation stra- tegies), prolonged immune suppressive therapy in high risk patients, awareness of signs and symptoms of Allo-LS and routine PFT after HCT have all contributed to a decrease in incidence of Allo-LS and early diagnosis even in the mildly affected or asymptomatic patient. Outcome of Allo-LS is still unsatisfactory, and further improvement of second line tre- atment strategies is needed for prompt adjustment of therapy in patients failing initial MP-pulse therapy. This should ideally be done in a randomized setting, in collaboration with other centers to get enough patients. Supportive care with attention for pulmonary rehabilitation and nutritional status is also very important. Translational research, with input from pulmonary-, infectiology- and transplant- research groups will hopefully lead to further understanding of this intriguing disease, and help in the development of new strategies to improve outcome and quality of life of our patients. 9