Stem cell transplantation
Utility of Positive Bronchoalveolar Lavage in Predicting Respiratory Failure After Hematopoietic Stem Cell Transplantation: A Retrospective Analysis

https://doi.org/10.1016/j.transproceed.2007.02.065Get rights and content

Abstract

Pulmonary complications occur frequently after hematopoietic stem cell transplantation (HSCT) and account for considerable mortality when associated with respiratory failure. Bronchoalveolar lavage (BAL) is commonly used in the diagnostic evaluation of pulmonary infiltrates in HSCT patients. Although the yield of BAL is well established in this setting, the impact on outcome is controversial. In addition, respiratory failure in HSCT patients is associated with high mortality. To determine if positive BAL predicted less respiratory failure and better survival, a retrospective review (between 1992 and 1998) of all HSCT patients who had bronchoscopy with BAL as part of their diagnostic evaluation for new pulmonary infiltrates was performed. Twenty-one patients met the inclusion criteria. Eleven patients (52%) had a positive BAL, defined as the isolation of infectious microorganisms or pulmonary hemorrhage in the lavage specimen. Most of the positive findings were pathogenic organisms (bacterial, fungal, and viral). Respiratory failure (defined as need for both intubation and mechanical ventilation) occurred in 11 of 21 patients (52%)—8 of 11 (73%) who had positive BAL compared with 3 of 10 (30%) who had negative BAL (P = .09). The overall mortality rate was 11 of 21 patients (52%). All deaths except one occurred as a direct result of respiratory failure. Although this study confirmed the high mortality rate in HSCT patients with respiratory failure, the BAL results were not predictive of outcome.

Section snippets

Methods

With Mayo Foundation Institutional Review Board approval, this retrospective review considered HSCT patients who had undergone bronchoscopy with BAL for the evaluation of pulmonary infiltrates between 1992 and 1998 at Mayo Clinic Jacksonville. All clinical and hospital records were reviewed, and patient data were collected. Pertinent clinical information such as patient demographics, pre-HSCT diagnosis, BAL results, need for mechanical ventilation, and survival duration were recorded. Positive

Results

During the study period, 72 patients underwent HSCT. Twenty-one patients (29%) had BAL. Of the 21, 12 (57%) were men. The mean ± SD age was 45 ± 15 years. The range of pre-HSCT diagnoses was broad: five myelomas, four lymphomas, three acute myeloid leukemias, two myelodysplasias, two chronic myelogenous leukemias, and six other. Twelve (57%) had peripheral stem cell transplantation, and 9 (43%) had allogeneic transplantation. A total of 27 BALs were performed in 21 HSCT patients with acute

Discussion

To my knowledge, this is the first study to look at both respiratory failure and mortality as primary outcomes. The incidence of respiratory failure in patients with positive BAL was twice that of patients with negative BAL, but the difference was not statistically significant. The mortality rate was also similar in the two groups. Prior studies have questioned the utility of bronchoscopy in changing outcomes.7, 8 The study by Dunagan et al7 had a similar mortality rate in the patients with

Acknowledgments

Dr Kenneth Yen, former pulmonary fellow, initiated the data collection. Editing, proofreading, and reference verification were provided by the Section of Scientific Publications, Mayo Clinic.

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