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\begin{document}

\title{PULMONARY SURVEILLANCE IN PEDIATRIC HEMATOPOIETIC STEM CELL TRANSPLANT--
A MULTINATIONAL MULTIDISCIPLINARY SURVEY}



\author[1]{Shivanthan Shanthikumar}%
\author[2]{William Gower}%
\author[3]{Matthew Abts}%
\author[4]{Deborah Liptzin}%
\author[5]{Elizabeth Fiorino}%
\author[6]{Anne Stone}%
\author[7]{Saumini Srinivasan}%
\author[2]{Timothy Vece}%
\author[7]{Nour Akil}%
\author[8]{Theresa Cole}%
\author[9]{Kenneth Cooke}%
\author[10]{Samuel Goldfarb}%
\affil[1]{The Royal Children's Hospital Melbourne}%
\affil[2]{University of North Carolina System}%
\affil[3]{Seattle Children's Hospital}%
\affil[4]{University of Colorado}%
\affil[5]{Weill Cornell Medicine}%
\affil[6]{Oregon Health and Science University}%
\affil[7]{Le Bonheur Children’s Hospital and the University of Tennessee School of Health Sciences}%
\affil[8]{Royal Children's Hospital}%
\affil[9]{Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center}%
\affil[10]{University of Minnesota System}%


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  \date{June 14, 2024}


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\begin{abstract}
Background Hematopoietic Stem Cell Transplant (HSCT) is an established
treatment for malignant and non-malignant conditions and pulmonary
disease is a leading cause of late term morbidity and mortality.
Accurate and early detection of pulmonary complications is a critical
step in improving long term outcomes. Existing guidelines for
surveillance of pulmonary complications post-HSCT contain conflicting
recommendations. Objective To determine the breadth of current practice
in monitoring for pulmonary complications of pediatric HSCT. Study
Design An institutional review board approved, online, anonymous
multiple-choice survey was distributed to HSCT and pulmonary physicians
from the United States of America and Australasia using the REDcap
platform. The survey was developed by members of the American Thoracic
Society Working Group on Complications of Childhood Cancer, and was
designed to assess patient management and service design. Results A
total of 40 (34.8\%) responses were received. The majority (62.5\%) were
pulmonologists, and 82.5\% were from the United States of America. In
all, 67.5\% reported having a protocol for monitoring pulmonary
complications and 50.0\% reported adhering ``well'' or ``very well'' to
protocols. Pulmonary function tests (PFTs) most commonly involved
spirometry and diffusion capacity for carbon monoxide. The frequency of
PFTs varied depending on time post-HSCT and presence of complications.
In all, 55.0\% reported a set threshold for a clinically significant
change in PFT. Conclusions These results illustrate current variation in
surveillance for pulmonary complications of pediatric HSCT. The results
of this survey will inform development of future guidelines for
monitoring of pulmonary complications after pediatric HSCT.%
\end{abstract}%



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