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Article: Clinical Utility of Computed Tomography Screening of Chest, Abdomen, and Sinuses before Hematopoietic Stem Cell Transplantation: The St. Jude Experience

TitleClinical Utility of Computed Tomography Screening of Chest, Abdomen, and Sinuses before Hematopoietic Stem Cell Transplantation: The St. Jude Experience
Authors
KeywordsPediatrics
Infection
Hematopoietic stem cell transplantation (HSCT)
Computed tomography (CT)
Allogeneic HSCT
Autologous HSCT
Issue Date2009
Citation
Biology of Blood and Marrow Transplantation, 2009, v. 15, n. 4, p. 490-495 How to Cite?
AbstractAll allogeneic (allo) and autologous (auto) hematopoietic stem cell transplantation (HSCT) recipients at St. Jude Children's Research Hospital undergo pre-HSCT computed tomography (CT) of the sinuses, chest, and abdomen because they are at significant risk for opportunistic infections. We studied whether this extensive routine imaging is warranted to detect infection despite the risk of additional radiation exposure. We reviewed the medical records of all children receiving allo- and auto-HSCT at St. Jude in 2004 and 2005. Of the 184 eligible patients who received 187 transplants, 131 received allografts and 56 autografts. Solid tumors and lymphomas were removed from the final analysis of the chest and abdomen CT as this imaging is typically warranted as part of disease restaging; thus, 111 allogeneic participants were included in this analysis. Both auto- and allo-recipients were evaluated by sinus CT and included in this final analysis. Most allo- and auto-HSCT recipients (≥80%) did not have sinus, pulmonary, cardiac, or gastrointestinal symptoms; >85% of the evaluable allo-recipients had no prior fungal infection. Eighty-eight allo- and 31 auto-HSCT recipients had abnormal sinus CT findings, all unrelated to the underlying disease. Sixty-two (55.9%) of the allo-recipients had normal chest CT and 85 (76.6%) had normal abdominal CT. Of the 18 allo-recipients who began new therapy based on these findings, only 2 (11.1%) were related to chest CT findings and the other 16 were related to sinus findings. Our findings suggest that pre-HSCT routine CT imaging of the abdomen may not be warranted in a subset of allogeneic recipients who are asymptomatic and without previous infectious findings. Thus, these patients may be spared unnecessary radiation exposure. Recipients undergoing auto-HSCT or allo-HSCT for lymphomas or solid tumors will routinely undergo chest and abdominal CT imaging as part of their disease evaluation. The decision to perform chest CT should be made judiciously based on a careful history and physical examination. Sinus imaging, which was frequently abnormal, may be justified in all patients to plan post-HSCT care. © 2009 American Society for Blood and Marrow Transplantation.
Persistent Identifierhttp://hdl.handle.net/10722/294426
ISSN
2022 Impact Factor: 4.3
2020 SCImago Journal Rankings: 2.301
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorKasow, Kimberly A.-
dc.contributor.authorKrueger, Jennifer-
dc.contributor.authorSrivastava, Deo Kumar-
dc.contributor.authorLi, Chenghong-
dc.contributor.authorBarfield, Raymond-
dc.contributor.authorLeung, Wing-
dc.contributor.authorHorwitz, Edwin M.-
dc.contributor.authorMadden, Renee-
dc.contributor.authorWoodard, Paul-
dc.contributor.authorHussain, Ishtiaq-
dc.contributor.authorMcCarville, M. Beth-
dc.contributor.authorHandgretinger, Rupert-
dc.contributor.authorHale, Gregory A.-
dc.date.accessioned2020-12-03T08:22:42Z-
dc.date.available2020-12-03T08:22:42Z-
dc.date.issued2009-
dc.identifier.citationBiology of Blood and Marrow Transplantation, 2009, v. 15, n. 4, p. 490-495-
dc.identifier.issn1083-8791-
dc.identifier.urihttp://hdl.handle.net/10722/294426-
dc.description.abstractAll allogeneic (allo) and autologous (auto) hematopoietic stem cell transplantation (HSCT) recipients at St. Jude Children's Research Hospital undergo pre-HSCT computed tomography (CT) of the sinuses, chest, and abdomen because they are at significant risk for opportunistic infections. We studied whether this extensive routine imaging is warranted to detect infection despite the risk of additional radiation exposure. We reviewed the medical records of all children receiving allo- and auto-HSCT at St. Jude in 2004 and 2005. Of the 184 eligible patients who received 187 transplants, 131 received allografts and 56 autografts. Solid tumors and lymphomas were removed from the final analysis of the chest and abdomen CT as this imaging is typically warranted as part of disease restaging; thus, 111 allogeneic participants were included in this analysis. Both auto- and allo-recipients were evaluated by sinus CT and included in this final analysis. Most allo- and auto-HSCT recipients (≥80%) did not have sinus, pulmonary, cardiac, or gastrointestinal symptoms; >85% of the evaluable allo-recipients had no prior fungal infection. Eighty-eight allo- and 31 auto-HSCT recipients had abnormal sinus CT findings, all unrelated to the underlying disease. Sixty-two (55.9%) of the allo-recipients had normal chest CT and 85 (76.6%) had normal abdominal CT. Of the 18 allo-recipients who began new therapy based on these findings, only 2 (11.1%) were related to chest CT findings and the other 16 were related to sinus findings. Our findings suggest that pre-HSCT routine CT imaging of the abdomen may not be warranted in a subset of allogeneic recipients who are asymptomatic and without previous infectious findings. Thus, these patients may be spared unnecessary radiation exposure. Recipients undergoing auto-HSCT or allo-HSCT for lymphomas or solid tumors will routinely undergo chest and abdominal CT imaging as part of their disease evaluation. The decision to perform chest CT should be made judiciously based on a careful history and physical examination. Sinus imaging, which was frequently abnormal, may be justified in all patients to plan post-HSCT care. © 2009 American Society for Blood and Marrow Transplantation.-
dc.languageeng-
dc.relation.ispartofBiology of Blood and Marrow Transplantation-
dc.subjectPediatrics-
dc.subjectInfection-
dc.subjectHematopoietic stem cell transplantation (HSCT)-
dc.subjectComputed tomography (CT)-
dc.subjectAllogeneic HSCT-
dc.subjectAutologous HSCT-
dc.titleClinical Utility of Computed Tomography Screening of Chest, Abdomen, and Sinuses before Hematopoietic Stem Cell Transplantation: The St. Jude Experience-
dc.typeArticle-
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1016/j.bbmt.2008.11.033-
dc.identifier.pmid19285637-
dc.identifier.pmcidPMC2679960-
dc.identifier.scopuseid_2-s2.0-61749095125-
dc.identifier.volume15-
dc.identifier.issue4-
dc.identifier.spage490-
dc.identifier.epage495-
dc.identifier.eissn1523-6536-
dc.identifier.isiWOS:000264616000012-
dc.identifier.issnl1083-8791-

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