Birgitta Versluijs

81 Pulmonary screening before hematopoietic cell transplantation in children Introduction Hematopoietic cell transplantation (HCT) is a curative treatment for various diseases. Pulmonary complications, both infectious and noninfectious, are frequently seen in pa- tients undergoing HCT. In children, the incidence of pulmonary complications varies from 25% to 74% and is associated with a significantly increased risk for mortality. 1-3 Be- cause of the risk of life-threatening complications of the procedure, patients are routinely screened for HCT eligibility. Lung screening can potentially impact selection of HCT patients as well as affect preemptive treatment and prognosis. Invasive fungal infections (IFI) are an important cause of morbidity and mortality during HCT. Diagnostic imaging, culturing pathogens, and antigen detection can be helpful to identify patients at high risk for IFI, which may guide therapy. 4 Also, respiratory viruses (RV) may have impact on the overall survival of HCT, either directly as a cause of pneumonitis in the severe immune-compromised patient or indi- rectly by triggering allo-immunity in the setting of allogeneic transplantation. 5 In 2008, we implemented extensive pre-HCT lung screening, which includes pulmona- ry function test (PFT), chest high-resolution computed tomography (HRCT), and bron- chial alveolar lavage (BAL) in all patients. Here, we evaluate the yield of such an extensive pulmonary screening program and describe our treatment guidelines according to these findings as well as the outcome of patients. Materials and methods Study population All consecutive pediatric patients undergoing a first allogeneic HCT in our center between January 2008 and August 2013 were included. Patients were enrolled in the HCT research protocol after providing written informed consent for data collection and analysis, according to national ethical regulations (Ethical Commission Number 05/143 and 11/063K). Patient characteristics (age, gender, underlying disease), clinical symptoms, results of pulmonary screening tests, and occurrence of symptomatic lung disease after HCT was registered. Pulmonary screening Standard pre-HCT pulmonary screening is performed in the week before transplantation and consists of a PFT, HRCT scan, and BAL. PFT includes spirometry, whole body plethysmography, and measurement of carbon monoxide diffusion capacity. Measurements are performed in children aged 5 years and 5