Pre-Hematopoietic Stem Cell Transplantation Lung Computed Tomography as an Alternative to the Pulmonary Function Test during the COVID-19 Pandemic

• Published in: Biology of blood and marrow transplantation Vol. 26; no. 12; pp. 2318 - 2322
• Main Authors: Tamaki, Masaharu, Nakasone, Hideki, Aikawa, Tadao, Nakamura, Yuhei, Kawamura, Masakatsu, Kawamura, Shunto, Takeshita, Junko, Yoshino, Nozomu, Misaki, Yukiko, Yoshimura, Kazuki, Matsumi, Shinpei, Gomyo, Ayumi, Tanihara, Aki, Kusuda, Machiko, Akahoshi, Yu, Kimura, Shun-ichi, Kako, Shinichi, Oyama-Manabe, Noriko, Kanda, Yoshinobu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020; American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc
• Subjects: Adolescent; Adult; Aged; Computed tomography; COVID-19; COVID-19 - diagnostic imaging; COVID-19 - epidemiology; COVID-19 - physiopathology; Female; Hematopoietic Stem Cell Transplantation; Humans; Lung - diagnostic imaging; Lung - physiopathology; Male; Middle Aged; Pandemics; Pulmonary function test; Respiratory Function Tests; Retrospective Studies; SARS-CoV-2; Supportive Care; Tomography, X-Ray Computed; COVID-19; Computed tomography; Pulmonary function test
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2020.08.025

•The pulmonary function test (PFT) is an important test for risk stratification before allogeneic hematopoietic stem cell transplantation (allo-HCT), although it might be preferable to avoid unnecessary PFT during the COVID-19 pandemic.•Our computed tomography (CT)-based model for predicting normal PFT showed relatively high specificity (>80%).•PFT might be omitted in patients with normal CT findings before allo-HCT. The pulmonary function test (PFT) is an important test for risk stratification before allogeneic transplantation (allo-HCT). However, it might be preferable to avoid PFT as much as possible in the recent era of coronavirus disease 2019 (COVID-19), because PFT requires forced expirations and might produce aerosols, increasing the risk of COVID-19 transmission. Therefore, we tried to predict normal PFT results before allo-HCT based on computed tomography (CT) findings. This study included 390 allo-HCT recipients at our center for whom lung CT images and PFT results before allo-HCT were available. Abnormal CT findings were less likely to be observed in the normal PFT group (47.0% versus 67.4%, P = .015), with a high negative predictive value of 92.9%. In a multivariate analysis, normal CT was significantly associated with normal PFT (odds ratio, 2.47; 95% confidence interval, 1.22 to 4.97; P = .012). A model for predicting normal PFT was constructed based on the results of a multivariate analysis, and the area under the curve of the receiver operating characteristic analysis was 0.656, which gave a sensitivity of 45.5% and a specificity of 86.0%. The relatively high specificity of the model suggested that PFT can be omitted in patients with normal CT findings before allo-HCT.