Language

English

Publication Date

8-1-2024

Journal

Transplantation and Cellular Therapy

DOI

10.1016/j.jtct.2024.05.012

PMID

38897861

PMCID

PMC11393806

PubMedCentral® Posted Date

8-1-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Hematopoietic stem cell transplantation (HSCT) is undertaken in children with the aim of curing a range of malignant and non-malignant conditions. Unfortunately, pulmonary complications, especially bronchiolitis obliterans syndrome (BOS), are a significant source of morbidity and mortality post-HSCT. Currently criteria developed by a National Institutes of Health (NIH) working group are used to diagnose BOS in children post-HSCT.

Unfortunately, during the development of a recent American Thoracic Society (ATS) Clinical Practice Guideline on this topic, it became apparent that there is evidence demonstrating the NIH criteria have significant limitations in the pediatric population, leading to late diagnosis of BOS. Specific limitations include use of an outdated pulmonary function testing reference equation, a reliance on spirometry, use of a fixed forced expiratory volume in 1 second (FEV1) threshold, focus on obstructive defects defined by FEV1/Vital Capacity, and a failure to acknowledge BOS and infection can co-exist. In this review, we summarize the evidence regarding the limitations of the current criteria. We also suggest potential evidence-based ideas for improving the criteria. Finally, we highlight new proposed criteria for post-HSCT BOS in children that were developed by the authors of the recently published ATS clinical practice guideline, and a pathway forward for improving timely diagnosis of BOS in children post-HSCT.

Keywords

Child, Humans, Bronchiolitis Obliterans Syndrome, Forced Expiratory Volume, Hematopoietic Stem Cell Transplantation, Practice Guidelines as Topic, Respiratory Function Tests, Bronchiolitis Obliterans Syndrome, Pediatrics, Stem Cell Transplantation

Published Open-Access

yes

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