Utility of Pre-HSCT Chest High Resolution Computed Tomography and Targeted Bronchoalveolar Lavage in Pediatric HSCT Recipients and Relationship to Post-HSCT Outcomes

Abstract

HCT; 162 with a MUD. For those who identified a MUD and proceeded to HCT, median time between FS and date of confirmatory donor HLA testing was 16 days (range 3-540). Median time from FS to donor information session was 58 days (range 1-645), FS to start of preparatory regimen (PR), 92 days (range 8-772), and FS to infusion, 107 days (range 22-786). An alternative donor source was used for 28 patients [22 CBU, 5 matched sibling, 1 haplo] when no MUD was identified. Additionally, 110 patients did not undergo HCT. The reasons for not proceeding with HCT were patient death (27), HCT not indicated (25), alternate therapy chosen (19), no suitable donor (15), family preference (2), and patient deemed ineligible (1). Eleven patients are still undergoing diagnostic evaluation, 4 are undergoing pre-HCT evaluation, and 6 were lost to follow-up. Our data show that under the best circumstances, a MUD can be identified quickly, with 44% of our patients moving from FS to confirmatory donor testing within 14 days. Time to PR and infusion is often influenced by variability in patients' condition. In cases where a donor is needed urgently but the search is not ideal, we have used haplo HCT. MUD could not be identified in only 5% of our last 300 searches and haplo HCT is of value in these patients.