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Transbronchial biopsy in the management of pulmonary complications of hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 53, pages 193–198 (2018)Cite this article

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Abstract

The utility of transbronchial biopsy in the management of pulmonary complications following hematopoietic stem cell transplantation (HSCT) has shown variable results. Herein, we examine the largest case series of patients undergoing transbronchial biopsy following HSCT. We performed a retrospective analysis of 130 transbronchial biopsy cases performed in patients with pulmonary complications post HSCT. Logistic regression models were applied to examine diagnostic yield, odds of therapy change and complications. The most common histologic finding on transbronchial biopsy was a nonspecific interstitial pneumonitis (n=24 cases, 18%). Pathogens identified by transbronchial biopsy were rare, occurring in <5% of cases. A positive transbronchial biopsy significantly increased the odds of a subsequent change in corticosteroid therapy (odds ratio (OR)=3.12; 95% confidence interval (CI) 1.18–8.23; P=0.02) but was not associated with a change in antibiotic therapy (OR=1.01; 95% CI 0.40–2.54; P=0.98) or changes in overall therapy (OR=1.92; 95% CI 0.79–4.70; P=0.15). Patients who underwent a transbronchial biopsy had increased odds of complications related to the bronchoscopy (OR=3.33, 95% CI 1.63–6.79; P=0.001). In conclusion, transbronchial biopsy may contribute to the diagnostic management of noninfectious lung injury post HSCT, whereas its utility in the management of infectious pulmonary complications of HSCT remains low.

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Acknowledgements

We thank the patients who participated and our study coordinator, Connie Varner. This study was supported by the NIH Grants AI117229 and HL127805 (BBM).

Author contributions

DNO’D, GAY and BBM conceived the study, contributed to analysis and interpretation and wrote the manuscript. ASD, TCH, KSB, CAB and XZ collected data. MX and SM carried out statistical analysis and contributed to the manuscript.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    D N O'Dwyer, X Zhou & B B Moore

  2. Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA

    A S Duvall, T C Hoffman, K S Bloye, C A Bulte & G A Yanik

  3. Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    M Xia & S Murray

  4. Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA

    B B Moore

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  1. D N O'Dwyer
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  2. A S Duvall
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  4. T C Hoffman
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  5. K S Bloye
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  10. G A Yanik
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Correspondence to D N O'Dwyer.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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O'Dwyer, D., Duvall, A., Xia, M. et al. Transbronchial biopsy in the management of pulmonary complications of hematopoietic stem cell transplantation. Bone Marrow Transplant 53, 193–198 (2018). https://doi.org/10.1038/bmt.2017.238

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