Pulmonary surveillance in pediatric hematopoietic stem cell transplant: A multinational multidisciplinary survey

Shivanthan Shanthikumar^{1

2

3}, William A Gower⁴, Matthew Abts^{5

6}, Deborah R Liptzin⁷, Elizabeth K Fiorino⁸, Anne Stone⁹, Saumini Srinivasan¹⁰, Timothy J Vece⁴, Nour Akil¹⁰, Theresa Cole¹¹, Kenneth R Cooke¹², Samuel B Goldfarb¹³

Affiliations

¹ Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
² Respiratory Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
³ Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
⁴ Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA.
⁵ Seattle Children's Hospital, Seattle, Washington, USA.
⁶ Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington, USA.
⁷ Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁸ Division of Pulmonology, Allergy, and Immunology, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA.
⁹ Division of Pulmonology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
¹⁰ Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹¹ Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia.
¹² Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹³ Division of Pulmonary and Sleep Medicine, Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.

PMID: 34319008
PMCID: PMC9124519
DOI: 10.1002/cnr2.1501

Pulmonary surveillance in pediatric hematopoietic stem cell transplant: A multinational multidisciplinary survey

Shivanthan Shanthikumar et al. Cancer Rep (Hoboken). 2022 May.

. 2022 May;5(5):e1501.

doi: 10.1002/cnr2.1501. Epub 2021 Jul 28.

Authors

Affiliations

¹ Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
² Respiratory Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
³ Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
⁴ Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA.
⁵ Seattle Children's Hospital, Seattle, Washington, USA.
⁶ Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington, USA.
⁷ Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁸ Division of Pulmonology, Allergy, and Immunology, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA.
⁹ Division of Pulmonology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
¹⁰ Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹¹ Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia.
¹² Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹³ Division of Pulmonary and Sleep Medicine, Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.

PMID: 34319008
PMCID: PMC9124519
DOI: 10.1002/cnr2.1501

Abstract

Background: Hematopoietic Stem Cell Transplant (HSCT) is an established treatment for malignant and non-malignant conditions and pulmonary disease is a leading cause of late term morbidity and mortality. Accurate and early detection of pulmonary complications is a critical step in improving long term outcomes. Existing guidelines for surveillance of pulmonary complications post-HSCT contain conflicting recommendations.

Aim: To determine the breadth of current practice in monitoring for pulmonary complications of pediatric HSCT.

Methods: An institutional review board approved, online, anonymous multiple-choice survey was distributed to HSCT and pulmonary physicians from the United States of America and Australasia using the REDcap platform. The survey was developed by members of the American Thoracic Society Working Group on Complications of Childhood Cancer, and was designed to assess patient management and service design.

Results: A total of 40 (34.8%) responses were received. The majority (62.5%) were pulmonologists, and 82.5% were from the United States of America. In all, 67.5% reported having a protocol for monitoring pulmonary complications and 50.0% reported adhering "well" or "very well" to protocols. Pulmonary function tests (PFTs) most commonly involved spirometry and diffusion capacity for carbon monoxide. The frequency of PFTs varied depending on time post-HSCT and presence of complications. In all, 55.0% reported a set threshold for a clinically significant change in PFT.

Conclusions: These results illustrate current variation in surveillance for pulmonary complications of pediatric HSCT. The results of this survey will inform development of future guidelines for monitoring of pulmonary complications after pediatric HSCT.

Keywords: diagnostic screening programs; pediatrics; respiratory tract diseases; stem cell transplantation.

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Conflict of interest statement

The authors have no conflicts to disclose.

Figures

**FIGURE 1**
Average number of HSCT performed per year at respondents centers

**FIGURE 2**
Summary of Pulmonary Function Tests performed before and after HSCT; DLCO (Diffusing capacity of the lungs for carbon monoxide)

See this image and copyright information in PMC

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Pulmonary surveillance in pediatric hematopoietic stem cell transplant: A multinational multidisciplinary survey

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Pulmonary surveillance in pediatric hematopoietic stem cell transplant: A multinational multidisciplinary survey

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Conflict of interest statement

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