Related Experiment Video
Updated: Apr 10, 2026
Detection of Residual Donor Erythroid Progenitor Cells after Hematopoietic Stem Cell Transplantation for Patients with Hemoglobinopathies
Published on: September 6, 2017
High Diagnostic Yield of Dedicated Pulmonary Screening before Hematopoietic Cell Transplantation in Children
Anne Birgitta Versluys1, Korstiaan van der Ent2, Jaap J Boelens1
1Paediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Insights
Pre-hematopoietic cell transplantation (HCT) screening identifies significant pulmonary abnormalities in children. Combining pulmonary function tests, HRCT scans, and BAL analysis aids in diagnosing and managing lung issues before HCT.
Area of Science:
- Pediatric Pulmonology
- Hematology
- Oncology
Background:
- Pulmonary complications are a major cause of morbidity and mortality following pediatric hematopoietic cell transplantation (HCT).
- Effective pre-transplant screening is crucial for identifying and managing potential pulmonary risks.
Purpose of the Study:
- To evaluate the diagnostic yield of a pre-HCT pulmonary screening program in children.
- To describe management guidelines based on screening findings and correlate them with post-HCT lung injury.
Main Methods:
- A pre-HCT screening protocol including pulmonary function tests (PFTs), chest high-resolution computed tomography (HRCT), and bronchial alveolar lavage (BAL).
- Systematic evaluation of screening results in 142 pediatric patients over the first 5 years of the program.
Main Results:
- Abnormalities were detected in 74% of patients; PFTs were abnormal in 66%, HRCT in 55% (19% clinically significant), and BAL in 43%.
- Screening results had diagnostic/therapeutic implications in 33% of patients.
- Pre-transplant HRCT findings were associated with post-transplant lung injury.
Conclusions:
- A comprehensive pre-HCT pulmonary screening combining PFTs, HRCT, and BAL identifies significant abnormalities in a substantial proportion of pediatric patients.
- This multi-modal screening approach provides valuable information on respiratory status (function, structure, microbial colonization).
- Further investigation is needed to determine if this screening improves patient outcomes.
Abstract:
Pulmonary complications are an important cause for treatment-related morbidity and mortality in hematopoietic cell transplantation (HCT) in children. The aim of this study was to investigate the yield of our pre-HCT pulmonary 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 computed tomography (HRCT), and bronchial alveolar lavage (BAL) before HCT. We systematically evaluated the yield during the first 5 years of our screening program. We included 142 consecutive children. In 74% of patients, abnormalities were found. In 66% of patients, 1 or more PFT results were <80% of normal. Chest HRCT showed abnormalities in 55%; 19% of these abnormalities were considered "clinically significant." BAL was abnormal in 43% of patients; 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 colonization), reveals important abnormalities in a substantial number of patients. Whether this improves patient outcome requires further investigation.
