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.

中文翻译：

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儿科造血干细胞移植后闭塞性细支气管炎综合征的检测：美国胸科学会官方临床实践指南。


背景：许多儿童接受同种异体造血干细胞移植（HSCT）以治疗恶性和非恶性疾病。不幸的是，HSCT后经常发生肺部并发症，其中闭塞性细支气管炎综合征（BOS）是最常见的非感染性肺部并发症。当前的国际指南包含有关 BOS HSCT 后监测的相互矛盾的建议，最近 NIH 研讨会强调需要采用标准化方法进行 HSCT 后监测。因此，本指南提供了一种基于证据的方法来检测儿童 HSCT 后 BOS。方法：一个多国、多学科专家小组确定了有关儿童 HSCT 后 BOS 监测和评估的六个问题。为了回答每个问题，我们对文献进行了系统回顾。建议分级、评估、制定和评估方法用于评估证据的质量和建议的强度。结果：小组成员考虑了每项建议的强度，并评估了应用干预措施的好处和风险。在制定建议时，专家组考虑了患者和护理人员的价值、护理成本和可行性。针对疑似 HSCT 后 BOS 儿童的肺功能检测和诊断检测的筛查作用提出了建议。根据德尔菲法，还提出了儿科 HSCT 后 BOS 的新诊断标准。结论：本文件提供了一种基于证据的方法来检测儿童 HSCT 后 BOS，同时还强调了实施每项建议的注意事项。 此外，该文件还描述了未来研究的重要领域。