Birgitta Versluijs

83 Pulmonary screening before hematopoietic cell transplantation in children Standard antimicrobial prophylaxis Antibiotic prophylaxis involved daily ciprofloxacin and fluconazole, from the start of con- ditioning until the resolution of neutropenia. Additional prophylaxis against Streptococ- cus viridans was given with cefazoline in the mucositis phase. Empiric antibiotic treat- ment for febrile neutropenia included vancomycin and ceftazidime. Pneumocystis jeroveci pneumonia prophylaxis was started from 1 month after transplantation as cotrimoxazole 3 times a week. In case of positive serology for herpes simplex virus in all patients, and in case of positive serology for varicella zoster virus in cord blood transplantation reci- pients, prophylaxis with aciclovir was given. No other antiviral prophylaxis was given. In patients at high risk for IFI, according to our protocol, based on pretreatment, duration of neutropenia, and history of fungal infection, Aspergillus prophylaxis was given with daily voriconazole or twice weekly amphotericin B. Practical guidelines according to findings on pulmonary screening Patients with severely impaired PFT (<50% of normal) were considered to have an unac- ceptable high risk for treatment-related mortality and were excluded for HCT. Patients with RV from BAL were considered to have a high risk for alloimmune-media- ted lung syndromes. In elective HCT procedures, HCT was postponed until the RV was cleared. In other cases when the underlying disease did not allow treatment delay tape- ring of immune suppression after HCT was adjusted to prevent allo-immune mediated lung syndromes. In cases with probable fungal disease (positive cultures or GM from BAL), antifungal treatment was considered. Patients with positive bacterial cultures from BAL were not treated, unless pulmonary symptoms developed. Bacterial culture results guide the choice of empirical antibiotic treatment for neutropenic fever after HCT. In patients with nodular lesions on HRCT, lung biopsy was considered to identify the possible infectious cause and antimicrobial resistance pattern. In patients with possible or proven IFI based on BAL findings, biopsy results, or HRCT findings, antifungal treatment was started and granulocyte transfusions or haploidenti- cal stem cell support (combined with cord blood grafts) were considered. Statistical analysis Calculation of mean values and standard deviation was done for PFTs. Comparing the results with predicted values for age, race, sex, and height-matched controls was done using t-test (test value 100%). Comparison of the means between the different disease groups was done using ANOVA. The chi-square test was used for comparison of pro- portions between 2 or more groups. Differences with a P value of < .05 were considered statistically significant. Associations between pre-HCT pulmonary screening findings and clinically manifested lung injury after HCT were analyzed using Cox proportional 5