Birgitta Versluijs

High diagnostic yield of dedicated pulmonary screening before hematopoietic cell transplantation in children A.B. Versluys, C.K. van der Ent, J.J. Boelens, T.F.W. Wolfs, P.A. de Jong, M.B. Bierings Biol Blood MarrowTransplant 2015; 21: 1622-1626 Abstract Pulmonary complications are an important cause for treatment-related morbidity and mortality in hematopoie- tic cell transplantation (HCT) in children. The aim of this study was to investigate the yield of our pre-HCT pulmo- nary 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 com- puted tomography (HRCT), and bronchial alveolar lavage (BAL) before HCT. We systematically evaluated the yield during the first 5 years of our screening program. We inclu- ded 142 consecutive children. In 74% of patients, abnorma- lities were found. In 66% of patients, 1 or more PFT results were <80% of normal. Chest HRCT showed abnormali- ties in 55%; 19% of these abnormalities were considered “clinically significant.” BAL was abnormal in 43% of pa- tients; 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 colo- nization), reveals important abnormalities in a substantial number of patients. Whether this improves patient outco- me requires further investigation. Blood and Marrow Transplantation Program, Department of Pediatrics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands A.B. Versluys M.B. Bierings J.J. Boelens Department of Paediatric Pulmonology, UMCU, Wilhelmina Children’s Hospital, Utrecht, The Netherlands C.K. van der Ent Department of Paediatric Infectious Diseases, UMCU, Wilhelmina Children's Hospital, Utrecht, The Netherlands T.F.W. Wolfs Department of Radiology, UMCU, Wilhelmina Child- ren's Hospital, Utrecht, The Netherlands P.A. de Jong