Birgitta Versluijs

58 Discussion At present, we cannot predict which RV-positive patients are actually at risk for develo- ping allo-LS. Early recognition of the disease by the detection of biomarkers associated with lung damage and the development of allo-LS, or the identification of certain risk groups by studying the genetic polymorphisms of innate immunity in these patients, might be of additional value to fine-tune the initiation or adjustment of immunosuppres- sive therapy in the HSCT setting. In conclusion, we have shown a clear relation between early RV infection and the deve- lopment of allo-LS in pediatric HSCT recipients. Tissue damage because of the persis- tence of RV in the lung might be a trigger for the development of allo-LS. aGVHD, but more likely greater immunosuppression because of the aGVHD, appears to protect for allo-LS. These findings suggest that prevention of RV infections early after HSCT is of utmost importance. In addition, prolonged immune suppression in transplant recipients with an RV infection might prevent development of allo-LS, in analogy with current prac- tice in lung transplantation. 3