Abstract
Introduction: Allogeneic bone marrow transplant (BMT) patients are prone to pulmonary infections and neutropenic fever due to their induction regimen, which involves prolonged myelosuppression. Therefore, chest imaging, such as chest x-ray or chest CT, is completed prior to allogeneic BMT. This pre-transplant screening is conducted with the goal of identifying and treating potential infections, which may help prevent post-transplant complications. The utility of this screening remains unclear, especially when imaging results reveal incidental findings in asymptomatic patients.
Objective: This study aims to investigate the frequency of positive findings during routine pre-transplant workup and whether those findings impact clinical decision-making and the timeline of allogeneic BMT. Through analysis of imaging, following interventions, and transplant timeline, we intend to comment on the clinical necessity of pre-transplant screening.
Methods: A retrospective chart review of 343 patients who received allogeneic BMTs at our institution from 2000 to 2024 was conducted. The presence or absence of pre-transplant chest imaging was documented along with positive or negative findings. Positive imaging was defined as acute changes such as nodes, calcifications, or multifocal pneumonia. If positive findings were present, the medical record was reviewed for any additional workup, which was then documented. The average time from imaging to transplant was found for both positive and negative imaging. Patients with imaging conducted more than 90 days before transplantation were excluded to reduce outliers and to account for potential factors that may have caused delays in transplant. A two-tailed, unpaired t-test assessed whether the means of two groups differed significantly.
Results: 246 patients out of the 343 reviewed had chest imaging prior to BMT. 42 (17%) patients were found to have positive chest imaging within 90 days of transplant, and 204 (83%) were found to have negative imaging. Only 6 patients who had positive chest imaging required further action to be taken before transplant. Action taken for these patients included referral to cardiothoracic surgery for right upper lobe wedge mass resection, infectious disease consults for pneumonia treatment, repeat chest CT and subsequent thoracentesis, pulmonary consult with no further action taken, MRI of adrenal gland requiring no intervention, and repeat chest CT and antibiotic treatment. Average time from imaging to transplant was 49 days for the group with positive imaging and 47 days for the group with negative imaging, with no significant difference between the two groups (p-value 0.668).
Conclusion: Pre-transplant chest x-ray and chest CT prior to allogeneic BMT do not seem to result in significant changes in clinical management or cause a delayed transplant timeline. As only 2% of patients who had imaging required further evaluation or treatment, the necessity of this imaging policy should be explored. The findings in this study suggest using a more discriminatory approach to pre-transplant chest imaging, which involves symptomatic patients or patients with a known history of pulmonary disease.
