The Yield of Bronchoalveolar Lavage in the Diagnosis of Pulmonary Involvement Among Immune-suppressed Patients With Hematologic Disorders

Abstract

Background Pulmonary complications are a major cause of morbidity and mortality among patients with hematologic malignancies and bone marrow transplantation (BMT) recipients. This study retrospectively evaluated the diagnostic yield of bronchoalveolar lavage (BAL) in this setup. Methods A total of 115 BAL procedures were performed on 94 patients with hematologic malignancies (n=28) and BMT recipients (n=87) for the diagnosis of lung infiltrates. BAL was considered effective if it provided a specific diagnosis or ruled out a suspected diagnosis that led to a change in therapy. The yield of the BAL and the distribution of the etiologies were compared among 3 subgroups of patients; hematologic malignancies (n=28), allogeneic BMT (n=50), and autologous BMT (n=37). Results A specific diagnosis was obtained in 30.4% [infectious: 22.6%; diffuse alveolar hemorrhage (DAH): 7.8%] and, in addition a therapeutic change was followed in 21.8%, producing a yield of 52.2%. Bacteria accounted for 54% and fungi for 30.8% of the infectious etiology. The yield of the BAL and the distribution of the etiologies to the lung infiltrates were similar in the 3 subgroups. Only 3 minor complications occurred during BAL. Conclusions This study has shown the effectiveness of BAL in providing a specific diagnosis or leading to a change in management in half the patients with hematologic malignancies or in BMT recipients with lung infiltrates. The relatively low rate of specific diagnosis may be explained by the changing spectrum of pulmonary diseases related to prophylaxis and early empiric therapy against respiratory pathogens.