Utility of flexible bronchoscopy in the evaluation of pulmonary infiltrates in the hematopoietic stem cell transplant population -- a single center fourteen year experience

Arch Bronconeumol. 2013 May;49(5):189-95. doi: 10.1016/j.arbres.2012.11.012. Epub 2013 Feb 27.
[Article in English, Spanish]

Abstract

Introduction: Pulmonary infiltrates are common within the hematopoietic stem cell transplant (HSCT) population and unfortunately portend an increased mortality. Bronchoscopy is often utilized as an initial diagnostic tool, but the literature supporting its diagnostic utility and effect on clinical management varies significantly. The aim of this study was to investigate the diagnostic ability, complication rate, and clinical impact of flexible bronchoscopy (FB) in evaluating pulmonary infiltrates in a large HSCT population.

Patients and method: Retrospective review of all patients undergoing FB after HSCT in the Bone Marrow Transplant Unit from 1996 to 2009.

Results: FB was performed 162times in 144patients with pulmonary infiltrates yielding positive results in 52.5%. The most common positive results were bacterial pneumonia (31%), fungal pneumonia (15%), and alveolar hemorrhage (11%). Treatment changes occurred in 44% of patients after FB. Treatment changes included antibiotic modification (59%), addition of corticosteroids (21%), antifungal modification (12%), and antiviral modification (7%). The overall complication rate associated with FB was 30%, although 84% of these complications were considered minor.

Conclusions: FB in patients with pulmonary infiltrates after HSCT should still be considered a valuable tool in the evaluation and management of pulmonary infiltrates in the HSCT population. Future prospective, multicenter randomized studies are needed to evaluate the overall clinical impact that bronchoscopic results and management changes have in this unique population.

Publication types

  • Evaluation Study

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Allografts
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / therapeutic use
  • Biopsy
  • Bronchial Spasm / etiology
  • Bronchoalveolar Lavage Fluid
  • Bronchoscopy / adverse effects
  • Bronchoscopy / methods
  • Bronchoscopy / statistics & numerical data*
  • Drug Therapy, Combination
  • Female
  • Hematologic Neoplasms / complications
  • Hematologic Neoplasms / surgery
  • Hematopoietic Stem Cell Transplantation*
  • Hemorrhage / diagnosis
  • Hemorrhage / etiology
  • Humans
  • Hypoxia / etiology
  • Lung Diseases / diagnosis*
  • Lung Diseases / drug therapy
  • Lung Diseases / etiology
  • Lung Diseases, Fungal / diagnosis
  • Lung Diseases, Fungal / drug therapy
  • Lung Diseases, Fungal / etiology
  • Lung Diseases, Fungal / microbiology
  • Male
  • Multiple Myeloma / complications
  • Multiple Myeloma / surgery
  • Pneumonia / diagnosis
  • Pneumonia / drug therapy
  • Pneumonia / etiology
  • Pneumonia / microbiology
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / drug therapy
  • Postoperative Complications / microbiology
  • Postoperative Complications / mortality
  • Retrospective Studies
  • Transplantation, Autologous

Substances

  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Antiviral Agents