TY - JOUR
T1 - Detection of Bronchiolitis Obliterans Syndrome after Pediatric Hematopoietic Stem Cell Transplantation An Official American Thoracic Society Clinical Practice Guideline
AU - Shanthikumar, Shivanthan
AU - Goldfarb, Samuel
AU - Abts, Matthew
AU - Barochia, Amisha
AU - Bergeron, Anne
AU - Blinman, Thane
AU - Bracken, Jennifer
AU - Calvo, Charlotte
AU - Casey, Alicia
AU - Charbek, Edward
AU - Cheng, Pi Chun
AU - Cole, Theresa S.
AU - Cooke, Kenneth R.
AU - Das, Shailendra
AU - Davies, Stella M.
AU - De, Aliva
AU - Deterding, Robin R.
AU - Gower, William A.
AU - Gross, Jessica
AU - Iyer, Narayan P.
AU - Liptzin, Deborah R.
AU - Mechinaud, Francoise
AU - Rayment, Jonathan H.
AU - Reardon, Erin E.
AU - Robinson, Paul D.
AU - Schultz, Kirk R.
AU - Sheshadri, Ajay
AU - Siddaiah, Roopa
AU - Srinivasan, Saumini
AU - Stone, Anne
AU - Tamae-Kakazu, Maximiliano
AU - Teusink-Cross, Ashley
AU - Towe, Christopher T.
AU - Walkup, Laura L.
AU - Yanik, Gregory A.
N1 - Publisher Copyright:
Copyright © 2024 by the American Thoracic Society.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - Background: Many children undergo allogeneic hematopoietic stem cell transplantation (HSCT) for the treatment of malignant and nonmalignant conditions. Unfortunately, pulmonary complications occur frequently post-HSCT, with bronchiolitis obliterans syndrome (BOS) being the most common noninfectious pulmonary complication. Current international guidelines contain conflicting recommendations regarding post-HSCT surveillance for BOS, and a recent NIH workshop highlighted the need for a standardized approach to post-HSCT monitoring. As such, this guideline provides an evidence-based approach to detection of post-HSCT BOS in children. Methods: A multinational, multidisciplinary panel of experts identified six questions regarding surveillance for, and evaluation of, post-HSCT BOS in children. A systematic review of the literature was undertaken to answer each question. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to rate the quality of evidence and the strength of recommendations. Results: The panel members considered the strength of each recommendation and evaluated the benefits and risks of applying the intervention. In formulating the recommendations, the panel considered patient and caregiver values, the cost of care, and feasibility. Recommendations addressing the role of screening pulmonary function testing and diagnostic tests in children with suspected post-HSCT BOS were made. Following a Delphi process, new diagnostic criteria for pediatric post-HSCT BOS were also proposed. Conclusions: This document provides an evidence-based approach to the detection of post-HSCT BOS in children while also highlighting considerations for the implementation of each recommendation. Further, the document describes important areas for future research.
AB - Background: Many children undergo allogeneic hematopoietic stem cell transplantation (HSCT) for the treatment of malignant and nonmalignant conditions. Unfortunately, pulmonary complications occur frequently post-HSCT, with bronchiolitis obliterans syndrome (BOS) being the most common noninfectious pulmonary complication. Current international guidelines contain conflicting recommendations regarding post-HSCT surveillance for BOS, and a recent NIH workshop highlighted the need for a standardized approach to post-HSCT monitoring. As such, this guideline provides an evidence-based approach to detection of post-HSCT BOS in children. Methods: A multinational, multidisciplinary panel of experts identified six questions regarding surveillance for, and evaluation of, post-HSCT BOS in children. A systematic review of the literature was undertaken to answer each question. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to rate the quality of evidence and the strength of recommendations. Results: The panel members considered the strength of each recommendation and evaluated the benefits and risks of applying the intervention. In formulating the recommendations, the panel considered patient and caregiver values, the cost of care, and feasibility. Recommendations addressing the role of screening pulmonary function testing and diagnostic tests in children with suspected post-HSCT BOS were made. Following a Delphi process, new diagnostic criteria for pediatric post-HSCT BOS were also proposed. Conclusions: This document provides an evidence-based approach to the detection of post-HSCT BOS in children while also highlighting considerations for the implementation of each recommendation. Further, the document describes important areas for future research.
KW - bronchiolitis obliterans syndrome
KW - pediatrics
KW - stem cell transplantation
UR - http://www.scopus.com/inward/record.url?scp=85199943663&partnerID=8YFLogxK
U2 - 10.1164/rccm.202406-1117ST
DO - 10.1164/rccm.202406-1117ST
M3 - Article
C2 - 38889365
AN - SCOPUS:85199943663
SN - 1073-449X
VL - 210
SP - 262
EP - 280
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 3
ER -