Birgitta Versluijs

87 Pulmonary screening before hematopoietic cell transplantation in children FIGURE 1. Prevalence of HRCT abnormalities before HCT, per disease group. 1. Immune deficiencies, n=27 2. Malignancies with chemotherapy, n=56 3. Other (inborn errors of metabolism, bone marrow failure, malignancies without chemotherapy), n=54 Relationship between different tests Figure 2 shows the yield of all screening tests. Abnormalities were found in tests of 74% of patients. We found abnormalities in radiological tests among patients with normal and abnormal PFTs, as well as positive microbial test results in patients with normal PFTs and normal HRCT. Impact on outcome In 46 patients, the screening outcome had implications, such as guided BAL/lung bio- psy (n=8), change in antifungal treatment/prophylaxis (n=12), granulocyte transfusions (n=2), addition of haploidentical stem cells (n=3), postponement of HCT (n=11), or gui- ded tapering of immune suppressive agents (n=35). These interventions overlapped in some patients. In 4 patients, the pre-HCT HRCT showed new or progressive signs of infiltrative fungal infection. Antifungal therapy was intensified in 3 based on resistance pattern of the cul- tured pathogen. In 2 patients, we postponed HCT. In 3 cord blood transplant recipients, we added haploidentical CD34+ cells from a family donor for early myeloid support, 5 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 ** p>0.05 any abnormality clinically significant abnormality NS