Home
|
Inbox
|
Search
|
View Abstract
Pulmonary Screening of Pediatric Hematopoietic Stem Cell Transplant Patients
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A6324 - Pulmonary Screening of Pediatric Hematopoietic Stem Cell Transplant Patients
Author Block: C. Towe1, N. Gloude2, J. El-Bietar3, M. Grimley3, L. Walkup1, J. C. Woods1, K. Myers3; 1Pediatric Pulmonary, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States, 2Pediatric Hematology / Oncology, University of California San Diego, San Diego, CA, United States, 3Pediatric Bone Marrow Transplant, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Rationale The pathophysiologic progression of bronchiolitis obliterans syndrome (BOS) in the pediatric hematopoietic stem cell transplant (HSCT) population is poorly characterized. Most studies have focused on long-term pulmonary function test (PFT) changes over 1 year post-HSCT. We embarked on a prospective BOS screening program to capture early changes in spirometry after pediatric HSCT.
Methods We performed a retrospective chart review of all pediatric and young adult patients receiving allogeneic HSCT since June 2016 who were prospectively screened per our clinical protocol. Patients ≥ 8 years of age underwent screening via spirometry pre-HSCT, around day 100 post-HSCT and one year post-HSCT using standard American Thoracic Society criteria.
Results Sixty-four of 76 total patients were alive greater than 100 days post-HSCT with 25 of 64 greater than 8 years of age. Sixteen (64%) patients completed screening spirometry at day 100. Seven (44%) and eight (50%) patients had abnormal forced vital capacities (FVC) and forced expiratory volume in 1 second (FEV1) around day 100 (108 days +/- 27), respectively. The eight patients over 1 year post-HSCT all completed screening spirometry (365 days +/- 40). Four (50%) patients had both abnormal FVC’s and FEV1’s. Three of these patients also had abnormal day 100 spirometry. The fourth patient had a greater than 10% decline in both FVC and FEV1 around day 100 post-HSCT compared to pre-HSCT testing. Twelve patients completed both pre- and 100-day post-HSCT spirometry. Eight (67%) and four (33%) had decreases in FVC and FEV1 greater than 10% at day 100 compared to pre-HSCT testing, respectively. Of the six of these patients with one year post-HSCT testing, two (33%) had a persistent decline in FVC while two (33%) had return of FVC to within 10% of pre-HSCT level. Two (33%) had a persistent 10% or greater decline in FEV1, while one (17%) recovered their FEV1.
Conclusion The preliminary results of our ongoing respiratory screening program demonstrate feasibility, with the successful capture of patients with early PFT decline, which may indicate early-onset BOS. All patients with abnormal PFT’s at one year post-HSCT had abnormal or significant changes in their PFT’s around day 100. This prospective screening program allows for earlier identification and intervention of pediatric HSCT patients at risk for BOS.
Author Block: C. Towe1, N. Gloude2, J. El-Bietar3, M. Grimley3, L. Walkup1, J. C. Woods1, K. Myers3; 1Pediatric Pulmonary, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States, 2Pediatric Hematology / Oncology, University of California San Diego, San Diego, CA, United States, 3Pediatric Bone Marrow Transplant, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Rationale The pathophysiologic progression of bronchiolitis obliterans syndrome (BOS) in the pediatric hematopoietic stem cell transplant (HSCT) population is poorly characterized. Most studies have focused on long-term pulmonary function test (PFT) changes over 1 year post-HSCT. We embarked on a prospective BOS screening program to capture early changes in spirometry after pediatric HSCT.
Methods We performed a retrospective chart review of all pediatric and young adult patients receiving allogeneic HSCT since June 2016 who were prospectively screened per our clinical protocol. Patients ≥ 8 years of age underwent screening via spirometry pre-HSCT, around day 100 post-HSCT and one year post-HSCT using standard American Thoracic Society criteria.
Results Sixty-four of 76 total patients were alive greater than 100 days post-HSCT with 25 of 64 greater than 8 years of age. Sixteen (64%) patients completed screening spirometry at day 100. Seven (44%) and eight (50%) patients had abnormal forced vital capacities (FVC) and forced expiratory volume in 1 second (FEV1) around day 100 (108 days +/- 27), respectively. The eight patients over 1 year post-HSCT all completed screening spirometry (365 days +/- 40). Four (50%) patients had both abnormal FVC’s and FEV1’s. Three of these patients also had abnormal day 100 spirometry. The fourth patient had a greater than 10% decline in both FVC and FEV1 around day 100 post-HSCT compared to pre-HSCT testing. Twelve patients completed both pre- and 100-day post-HSCT spirometry. Eight (67%) and four (33%) had decreases in FVC and FEV1 greater than 10% at day 100 compared to pre-HSCT testing, respectively. Of the six of these patients with one year post-HSCT testing, two (33%) had a persistent decline in FVC while two (33%) had return of FVC to within 10% of pre-HSCT level. Two (33%) had a persistent 10% or greater decline in FEV1, while one (17%) recovered their FEV1.
Conclusion The preliminary results of our ongoing respiratory screening program demonstrate feasibility, with the successful capture of patients with early PFT decline, which may indicate early-onset BOS. All patients with abnormal PFT’s at one year post-HSCT had abnormal or significant changes in their PFT’s around day 100. This prospective screening program allows for earlier identification and intervention of pediatric HSCT patients at risk for BOS.
|
Home
|
Inbox
|
Search
|