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Acute Leukemias

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

Leukemia volume 22, pages 1361–1367 (2008)Cite this article

Abstract

In patients with hematological malignancy (HM) developing acute respiratory failure (ARF) bronchoalveolar lavage (BAL) is considered as a major diagnostic tool. However, the benefit/risk ratio of this invasive procedure is probably lower in the subset of patients with acute myeloid leukemia (AML). The study was to analyze the yield of BAL performed in HM patients (n=175) with AML or lymphoid malignancies (LM) admitted in intensive care unit (ICU) for ARF and pulmonary infiltrates. BAL was performed in 121 patients (53/73 AML patients (73%) and 68/102 LM patients (67%)) without a definite diagnosis at admission or contraindication for fiberoptic bronchoscopy. Life-threatening complications were noticed in 12/121 patients (10%). The overall diagnostic yield of BAL was 47% (25/53) in AML patients and 50% (34/68) in LM patients. A microorganism was recovered from BAL in 23% (12/53) of AML patients and 41% (28/68) of LM patients (P<0.005). BAL results induced significant therapeutic changes in 17% (9/53) of AML patients vs 35% (24/68) of LM patients (P=0.039). This study underlines the rather low diagnostic yield of BAL for infectious diagnosis and the low rate of therapeutic changes induced by its results in AML patients with ARF admitted in ICU.

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Acknowledgements

We thank Professor Elie Azoulay for his precious help and judicious comments regarding the paper.

Author contribution: Conception and design: Antoine Rabbat and Driss Chaoui; Provision of study material or patients: Antoine Rabbat, Driss Chaoui, Aurélie Lefebvre, Ollivier Legrand, Christine Lorut, Jean-Pierre Marie, Gérard Huchon; Collection and assembly of data: Antoine Rabbat, Driss Chaoui, Aurélie Lefebvre, Nicolas Roche; Data analysis and interpretation: Antoine Rabbat, Driss Chaoui, Aurélie Lefebvre, Nicolas Roche, Ollivier Legrand, Christine Lorut, Jean-Pierre Marie; Manuscript writing: Antoine Rabbat, Driss Chaoui, Aurélie Lefebvre, Nicolas Roche; Final approval of the manuscript: Antoine Rabbat, Driss Chaoui, Aurélie Lefebvre, Ollivier Legrand, Christine Lorut, Nicolas Roche, Jean-Pierre Marie, Gérard Huchon

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Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, Hôtel-Dieu Hospital, AP-HP, Université Paris Descartes, Paris, France

    A Rabbat, A Lefebvre, N Roche, C Lorut & G Huchon

  2. Department of Hematology/Oncology, Hôtel-Dieu Hospital, AP-HP, Université Paris Pierre et Marie Curie, UMR S 736, Paris, France

    D Chaoui, O Legrand, B Rio & J-P Marie

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  1. A Rabbat
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Correspondence to A Rabbat.

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Rabbat, A., Chaoui, D., Lefebvre, A. et al. Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?. Leukemia 22, 1361–1367 (2008). https://doi.org/10.1038/leu.2008.100

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