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