Inflammatory mediators in BAL fluid as markers of evolving pneumonia in leukocytopenic patients.
OBJECTIVE
Pneumonia during chemotherapy-induced leukocytopenia is a major cause of overall treatment failure in patients with hematologic malignancies. To improve outcome in these high-risk patients, early diagnosis of pulmonary infiltrates and institution of adequate antimicrobial treatment are mandatory. To identify patients with evolving pneumonia, we have prospectively studied the prognostic value of cytokine and complement measurements in early BAL samples from febrile leukocytopenic patients.


METHODS
Prospective, comparative study.


METHODS
Hematology/oncology section of a university hospital.


METHODS
Twenty-one patients with leukocytopenia (WBC count < 1.000/microL) following cytoreductive chemotherapy for malignant disorders.


METHODS
Early BAL sampling primarily for microbiologic diagnostic purposes.


RESULTS
Proinflammatory cytokines and activated complement components were measured in the BAL aspirates and the results were related to the prevalence or subsequent evolution of overt pneumonia. Of the 21 patients studied, 10 patients presented with overt pneumonia at BAL sampling (group A), 5 patients developed objective signs of pneumonia 3 to 5 days after BAL (group B), and 6 patients remained free of pneumonia during follow-up (group C). In comparison with group C, patients in groups A and B both had distinctly elevated bronchoalveolar levels of tumor necrosis factor-alpha, interleukin-6, granulocyte colony-stimulating factor, C3a, and C5a.


CONCLUSIONS
Cytokine and complement determinations in early BAL samples may aid in the identification of febrile leukocytopenic patients with evolving pneumonia 3 to 5 days prior to the manifestation of diagnostic clinical and radiographic signs.
Kiehl
M G
MG
Department of Internal Medicine, Hematology/Oncology Section, University of Muenster, Germany.
Ostermann
H
H
Thomas
M
M
Birkfellner
T
T
Kienast
J
J
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D015415:Biomarkers; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D003165:Complement System Proteins / Q000032:analysis; D016207:Cytokines / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis*; D007958:Leukocyte Count; D007970:Leukopenia / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies
D000970:Antineoplastic Agents; D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators; D003165:Complement System Proteins