Abstract
Patients who undergo allogeneic hematopoietic SCT (HSCT) are prone to pulmonary infections. Between 1998 and 2004, a total of 450 patients underwent HSCT at Karolinska University Hospital, Huddinge. Pneumonia was diagnosed in 167 patients (37%), including 42 children. Bronchoalveolar lavage (BAL) was performed on 68 occasions in 57 patients (six children). In 110 patients (36 children) with pneumonia, BAL was not performed. BAL contributed to the diagnosis in 43 cases (63%) and to relevant findings in 53 cases: bacteria (n=13, 24%), viruses (n=28, 53%) and fungi (n=12, 23%). In 25 cases BAL was negative. In 15 of these cases, BAL was performed ⩾4 days after chest X-ray, and in four cases not in the same segment as the infiltrations. The median time between radiographic findings and positive BAL was 2 (0–15) days, and a negative BAL 6 (1–30) days (P<0.001). Antimicrobial treatment was administered to 79% patients with positive findings, and to 92% with negative findings at the time of BAL. No serious complications due to the procedure were reported. BAL resulted in a changed treatment in 32/68 (47%) episodes of pneumonia. To conclude, BAL is a safe and useful diagnostic procedure that should be performed early after the onset of pneumonia following allogeneic HSCT.
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References
Hohenthal U, Itala M, Salonen J, Sipila J, Rantakokko-Jalava K, Meurman O et al. Bronchoalveolar lavage in immunocompromised patients with haematological malignancy—value of new microbiological methods. Eur J Haematol 2005; 74: 203–211.
Lim do H, Lee J, Lee HG, Park BB, Peck KR, Oh WS et al. Pulmonary complications after hematopoietic stem cell transplantation. J Korean Med Sci 2006; 21: 406–411.
Glazer M, Breuer R, Berkman N, Lossos IS, Kapelushnik J, Nagler A et al. Use of fiberoptic bronchoscopy in bone marrow transplant recipients. Acta Haematol 1998; 99: 22–26.
Hofmeister CC, Czerlanis C, Forsythe S, Stiff PJ . Retrospective utility of bronchoscopy after hematopoietic stem cell transplant. Bone Marrow Transplant 2006; 38: 693–698.
Huaringa AJ, Leyva FJ, Signes-Costa J, Morice RC, Raad I, Darwish AA et al. Bronchoalveolar lavage in the diagnosis of pulmonary complications of bone marrow transplant patients. Bone Marrow Transplant 2000; 25: 975–979.
Whittle AT, Davis M, Johnson PR, Leonard RC, Greening AP . The safety and usefulness of routine bronchoscopy before stem cell transplantation and during neutropenia. Bone Marrow Transplant 1999; 24: 63–67.
Feinstein MB, Mokhtari M, Ferreiro R, Stover DE, Jakubowski A . Fiberoptic bronchoscopy in allogeneic bone marrow transplantation: findings in the era of serum cytomegalovirus antigen surveillance. Chest 2001; 120: 1094–1100.
White P, Bonacum JT, Miller CB . Utility of fiberoptic bronchoscopy in bone marrow transplant patients. Bone Marrow Transplant 1997; 20: 681–687.
Olerup O, Zetterquist H . HLA-DR typing by PCR amplification with sequence-specific primers (PCR-SSP) in 2 h: an alternative to serological DR typing in clinical practice including donor-recipient matching in cadaveric transplantation. Tissue Antigens 1992; 39: 225–235.
Uzunel M, Remberger M, Sairafi D, Hassan Z, Mattsson J, Omazic B et al. Unrelated versus related allogeneic stem cell transplantation after reduced intensity conditioning. Transplantation 2006; 82: 913–919.
Ringden O, Ruutu T, Remberger M, Nikoskelainen J, Volin L, Vindelov L et al. A randomized trial comparing busulfan with total body irradiation as conditioning in allogeneic marrow transplant recipients with leukemia: a report from the Nordic Bone Marrow Transplantation Group. Blood 1994; 83: 2723–2730.
Remberger M, Svahn BM, Hentschke P, Lofgren C, Ringden O . Effect on cytokine release and graft-versus-host disease of different anti-T cell antibodies during conditioning for unrelated haematopoietic stem cell transplantation. Bone Marrow Transplant 1999; 24: 823–830.
Ringden O, Remberger M, Persson U, Ljungman P, Aldener A, Andstrom E et al. Similar incidence of graft-versus-host disease using HLA-A, -B and -DR identical unrelated bone marrow donors as with HLA-identical siblings. Bone Marrow Transplant 1995; 15: 619–625.
Sparrelid E, Hagglund H, Remberger M, Ringden O, Lonnqvist B, Ljungman P et al. Bacteraemia during the aplastic phase after allogeneic bone marrow transplantation is associated with early death from invasive fungal infection. Bone Marrow Transplant 1998; 22: 795–800.
Ljungman P, Lore K, Aschan J, Klaesson S, Lewensohn-Fuchs I, Lonnqvist B et al. Use of a semi-quantitative PCR for cytomegalovirus DNA as a basis for pre-emptive antiviral therapy in allogeneic bone marrow transplant patients. Bone Marrow Transplant 1996; 17: 583–587.
Ljungman P, Aschan J, Lewensohn-Fuchs I, Carlens S, Larsson K, Lonnqvist B et al. Results of different strategies for reducing cytomegalovirus-associated mortality in allogeneic stem cell transplant recipients. Transplantation 1998; 66: 1330–1334.
De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008; 46: 1813–1821.
Ljungman P, Griffiths P, Paya C . Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis 2002; 34: 1094–1097.
Milburn HJ, Prentice HG, du Bois RM . Role of bronchoalveolar lavage in the evaluation of interstitial pneumonitis in recipients of bone marrow transplants. Thorax 1987; 42: 766–772.
Heurlin N, Markling L, Barkholt L, Lonnqvist B, Andersson J, Ringden O . Rapid detection of cytomegalovirus antigen on alveolar cells in bronchoalveolar fluid from transplant patients with cytomegalovirus pneumonia. Clin Transplant 1994; 8: 466–473.
Heurlin N, Lonnqvist B, Tollemar J, Ehrnst A . Fiberoptic bronchoscopy for diagnosis of opportunistic pulmonary infections after bone marrow transplantation. Scand J Infect Dis 1989; 21: 359–366.
Dunagan DP, Baker AM, Hurd DD, Haponik EF . Bronchoscopic evaluation of pulmonary infiltrates following bone marrow transplantation. Chest 1997; 111: 135–141.
Gruson D, Hilbert G, Valentino R, Vargas F, Chene G, Bebear C et al. Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates. Crit Care Med 2000; 28: 2224–2230.
Campbell JH, Blessing N, Burnett AK, Stevenson RD . Investigation and management of pulmonary infiltrates following bone marrow transplantation: an eight year review. Thorax 1993; 48: 1248–1251.
Cordonnier C, Bernaudin JF, Bierling P, Huet Y, Vernant JP . Pulmonary complications occurring after allogeneic bone marrow transplantation. A study of 130 consecutive transplanted patients. Cancer 1986; 58: 1047–1054.
Hohenadel IA, Kiworr M, Genitsariotis R, Zeidler D, Lorenz J . Role of bronchoalveolar lavage in immunocompromised patients with pneumonia treated with a broad spectrum antibiotic and antifungal regimen. Thorax 2001; 56: 115–120.
Kasow KA, King E, Rochester R, Tong X, Srivastava DK, Horwitz EM et al. Diagnostic yield of bronchoalveolar lavage is low in allogeneic hematopoietic stem cell recipients receiving immunosuppressive therapy or with acute graft-versus-host disease: the St Jude experience, 1990–2002. Biol Blood Marrow Transplant 2007; 13: 831–837.
Afessa B, Peters SG . Major complications following hematopoietic stem cell transplantation. Semin Respir Crit Care Med 2006; 27: 297–309.
Boeckh M, Leisenring W, Riddell SR, Bowden RA, Huang ML, Myerson D et al. Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood 2003; 101: 407–414.
Singh N, Paterson DL . Aspergillus infections in transplant recipients. Clin Microbiol Rev 2005; 18: 44–69.
Grow WB, Moreb JS, Roque D, Manion K, Leather H, Reddy V et al. Late onset of invasive aspergillus infection in bone marrow transplant patients at a university hospital. Bone Marrow Transplant 2002; 29: 15–19.
Marr KA, Carter RA, Boeckh M, Martin P, Corey L . Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood 2002; 100: 4358–4366.
Cone RW, Hackman RC, Huang ML, Bowden RA, Meyers JD, Metcalf M et al. Human herpesvirus 6 in lung tissue from patients with pneumonitis after bone marrow transplantation. N Engl J Med 1993; 329: 156–161.
Hentrich M, Oruzio D, Jager G, Schlemmer M, Schleuning M, Schiel X et al. Impact of human herpesvirus-6 after haematopoietic stem cell transplantation. Br J Haematol 2005; 128: 66–72.
Bonten MJ, van Tiel FH, van der Geest S, Stobberingh EE, Gaillard CA . Enterococcus faecalis pneumonia complicating topical antimicrobial prophylaxis. N Engl J Med 1993; 328: 209–210.
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Forslöw, U., Remberger, M., Nordlander, A. et al. The clinical importance of bronchoalveolar lavage in allogeneic SCT patients with pneumonia. Bone Marrow Transplant 45, 945–950 (2010). https://doi.org/10.1038/bmt.2009.268
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DOI: https://doi.org/10.1038/bmt.2009.268
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