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Correspondence to Author: Braham Tare Uacoub, 

Braham Tare Uacoub, Moffitt Cancer Center, 12902 Magnolia Drive. Tampa, Florida.

Abstract : Pneumonia causes considerable morbidity and mortality in leukemic and bone recipients of bone marrow transplants. We investigated the bronchoalveolar lavage’s (BAL) diagnostic yield in these newly infiltrated patients. Approximately 200 patients who had bronchoscopy at a single university cancer hospital and were not HIV leukemic or receiving hematopoietic stem cell transplantation (HSCT) had their retrospective charts reviewed. In this sample, a higher yield was linked to antimicrobial usage for less than 24 hours at the time of BAL (56.8% versus 32.8%, p<0.001). This supports the use of BAL for bronchoscopy in leukemic and HSC patients within 24 hours of starting antibiotic medication.

Introduction: In patients receiving bone marrow transplants and leukemias, pneumonia carries a high risk of morbidity and mortality. 1, 2 Concern is raised for both viral and non-infectious etiologies when pulmonary infiltrates arise in the context of such immunocompromise, some of which may be treated. When the infiltrates occur, many of these patients are given broad-spectrum antibiotics as a preventive measure or as a form of treatment. In clinical practice, bronchoscopy is frequently used to diagnose immune-compromised patients with lung infiltrates. This procedure has been welldocumented.3,4 Several options are available for sampling the lower respiratory tract during a bronchoscopy. Among these, bronchoalveolar lavage (BAL) has been demonstrated to be less risky than transbonchial biopsy and is particularly effective in obtaining samples from the alveoli.4,5 In fact, BAL is a standard clinical procedure and has been shown to be an effective diagnostic technique for determining non-infectious etiologies as well as causal infections in immunocompromised populations3. When immunocompromised patients, such as those with HIV or solid organ transplants, have lung infiltrates, the reported diagnostic yield of BAL varies greatly, from 22 to 80%.5–9 BAL sensitivity studies in patients undergoing hematopoietic stem cell transplantation (HSCT) show yields between 22 to 65%.6, 7, 9, and 12 Regarding the BAL yield in non-resolving pneumonia, a study conducted in a general intensive care unit (ICU) settings.

Citation:

Braham Tare Uacoub. Diagnostic Value of Bronchoalveolar Lavage in Leukemic and Bone Marrow Transplant Patients: The Impact of Antimicrobial Therapy. The American Journal of Hematology 2024.