Bronchiolitis Obliterans Syndrome Following Pediatric Hematopoietic Stem Cell Transplant
Publication Date: June 18, 2024
Key Points
Key Points
- Pulmonary complications occur frequently following pediatric hematopoietic stem cell transplant (HSCT).
- Pulmonary complications are a significant contributor to morbidity and mortality, affecting 25% to 60% children following HSCT and causing 25% to 65% of non-relapse mortality.
- The most common non-infectious pulmonary complication following HSCT is bronchiolitis obliterans syndrome (BOS), a manifestation of lung chronic graft vs. host disease (cGvHD) affecting 4.5–8.3% of children post-HSCT.
- Given that initial phases of BOS are often asymptomatic, surveillance with pulmonary function testing (PFT) is recommended.
Diagnosis
...gnosis...
...ation 1We recommend pre-HSCT spirometry, static l...
...on 2aWe suggest active surveillanc...
...mendation 2bWe suggest spirometry and where feasi...
...mmendation 2cFor long-term follow-up in...
...ation 3aAt centers with adequate technic...
...dation 3bAt centers with adequate te...
...4aWe suggest performing a chest computed to...
...ndation 4bWe suggest performing a chest CT...
Recommendation 5We suggest bronchoscopy with br...
...ndation 6We suggest surgical lung...
Table 1. Recommended Frequency of PF...
...le 2. Recommendations for Chest CT in Children Un...
Table 3. Role of Bronchoscopy With BAL in...
...able 4. New Proposed Criteria for Diagnosis...
...Surveillance and Diagnosis of BOS...