Birgitta Versluijs

91 Pulmonary screening before hematopoietic cell transplantation in children Figure 2 illustrates that all tests contribute separately to information regarding pulmona- ry status in pre-HCT children. This argues that all these screening modalities, reflecting different domains of respiratory status (function, structure, and microbial colonization), should be done in all pediatric pre-HCT patients, if a sensitive pre-HCT screening for pulmonary pathology is desired. The impact of the finding and the invasiveness of the test should guide clinicians in decision-making on whether or not to perform all tests. As far as we know, this is the first report on such comprehensive pulmonary screening with PFT, HRCT, and BAL in a large cohort of children before HCT. We have shown considerable decrease in pulmonary function, a significant amount of clinical important HRCT findings, and high prevalence of infectious agents. This is most likely because of underlying disease, pretreatment with chemotherapy, and the age distribution of our patients. In this cohort of patients, there is a significant association between clinically significant HRCT findings before HCT and lung injury after HCT. The findings in BAL and PFT were not related with outcome. This might be due to small numbers. We might also conclude that with current treatment strategies for this group of pulmo- nary compromised patients, we manage to have comparable outcome. We conclude that this screening protocol is feasible and provides important information for risk classification with therapeutic consequences. We would advocate all 3 screening methods, as they all contribute separately. Prospective studies are needed to further iden- tify the importance of baseline abnormalities in the risk for pulmonary complications and treatment-related mortality and whether outcome is improved by using intensive screening. 5