Screening Chest CT Prior to Allogenic Hematopoietic Stem Cell Transplantation

Area of Science:

• Hematology
• Pulmonology
• Radiology
• Oncology

Background:

• Pulmonary complications are a leading cause of death after allogeneic hematopoietic stem cell transplantation (alloHSCT).
• Traditional chest X-ray (CXR) screening may miss critical pulmonary abnormalities.
• Chest computed tomography (CT) offers a more detailed imaging modality for pre-transplant evaluation.

Purpose of the Study:

• To determine the prevalence of pulmonary abnormalities detected by chest CT in patients evaluated for alloHSCT.
• To assess the impact of these CT findings on transplant eligibility and post-transplant outcomes.
• To compare the sensitivity of chest CT versus CXR in detecting abnormalities.

Main Methods:

• Retrospective analysis of 511 adult patients undergoing evaluation for alloHSCT between January 2013 and December 2020.
• Review of screening chest CT scans for pulmonary abnormalities.
• Correlation of CT findings with subsequent interventions, transplant outcomes, and survival data.

Main Results:

• Abnormalities were detected in 39% of patients via chest CT, most commonly pulmonary nodules (35%), consolidation (19%), and ground-glass opacities (15%).
• Chest CT identified abnormalities missed by CXR in nearly half of affected patients (48%).
• Patients with abnormal CT findings had significantly worse overall survival (P=.032), non-relapse mortality (P=.015), and pulmonary-related mortality (P<.001).

Conclusions:

• Pre-transplantation chest CT screening is valuable for detecting infections and malignancies, enabling timely interventions.
• Early detection and management of CT-identified abnormalities can mitigate serious post-transplant complications.
• While beneficial, abnormal CT findings prior to alloHSCT may indicate a poorer overall prognosis.