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Summary for Clinicians: Clinical Practice Guideline for the Detection of Bronchiolitis Obliterans Syndrome after Pediatric Hematopoietic Stem Cell Transplant
Hematopoietic stem cell transplant (HSCT) is an established treatment for many pediatric malignant and nonmalignant conditions with increasing rates each year worldwide. Although overall survival after HSCT has improved, pulmonary complications are the leading cause of nonrelapse mortality. Bronchiolitis obliterans syndrome (BOS), a manifestation of chronic graft-versus-host disease in the lung, is characterized by progressive obstructive lung disease and is associated with high morbidity and mortality. The diagnosis of BOS is challenging because the initial phases are often asymptomatic; therefore, screening with pulmonary function testing is recommended.
Current international guidelines lack a clear standardized approach to post-HSCT monitoring. In addition, the current diagnostic criteria are largely extrapolated from adult data and are contingent on spirometry, which many children struggle to perform reliably.
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Target Audience
Pulmonologists, critical care specialists, translational researchers, and clinicians
Learning Objectives
At the conclusion of this activity, learners should be able to:
- Recognize the current challenges in the detection of bronchiolitis obliterans syndrome (BOS) in pediatric hematopoietic stem cell transplantation (HSCT) recipients.
- Identify best practices for diagnosis of pediatric BOS after stem cell transplantation.
- Describe the newly proposed diagnostic criteria for pediatric post-HSCT BOS.
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The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Disclosure Declaration
Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Pi Chun Cheng, M.D., M.S., reported no relevant financial relationships with ineligible companies.
Amisha Barochia, M.B.B.S., M.H.S., A.T.S.F., reported no relevant financial relationships with ineligible companies.
Shipra Rai, M.D., M.P.H., reported no relevant financial relationships with ineligible companies.
Samuel Goldfarb, M.D., reported no relevant financial relationships with ineligible companies.
Shivanthan Shanthikumar, M.B.B.S., Ph.D., reported no relevant financial relationships with ineligible companies.
Narayan P. Iyer, M.D., reported no relevant financial relationships with ineligible companies.
Joseph K. Ruminjo, M.D., reported no relevant financial relationships with ineligible companies. He is an employee of the American Thoracic Society.
Carey C. Thomson, M.D., M.P.H., reported personal fees from Median Technologies and UpToDate.
Off-Label Usage Disclosure
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Disclosures of AnnalsATS CME Planners
The Annals of the American Thoracic Society (AnnalsATS) original research, commentaries, reviews, and educational content of interest to clinicians and clinical investigators in pediatric and adult pulmonary and sleep medicine and medical critical care. The scope of the journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists, and the advancement of public health.
The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence supporting the response to the question.
AnnalsATS CME Planners
Margaret M. Hayes, M.D.
Harvard Medical School, Boston, MA, USA
Dr. Hayes reported receiving payments as an author for a chapter on heliox for UpToDate.
Caroline Okorie, M.D., M.P.H.
Stanford University School of Medicine, Stanford, CA, USA
Dr. Okorie reported no financial relationships with ineligible companies.
All relevant financial relationships have been reviewed and mitigated.
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Available Credit
- 1.00 AMA PRA Category 1 Credit(s)™The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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