title: Bronchoalveolar cytology for diagnosing pulmonary GVHD after bone marrow transplant in children.
abstract: BACKGROUND
  Cytological composition of bronchoalveolar lavage (BAL) fluid in pediatric bone marrow transplant (BMT) recipients with pulmonary complications has not been comprehensively described and BAL specific markers of pulmonary GVHD are lacking. The aim of this retrospective study was to assess the role of BAL in the diagnosis of pulmonary GVHD by comparing BAL cytological findings between pediatric allogenic BMT patients with pulmonary complications and oncology children receiving chemotherapy alone.
  
  
  METHODS
  Retrospective analysis of BAL specimens for cytology, total and differential cell counts and presence of infections.
  
  
  RESULTS
  Seventeen BMT and 13 chemotherapy BAL were analyzed. BAL total cell count was increased but similar between groups (96.9 x 10(4) vs. 98.2 x 10(4), P = NS). BAL cellular composition differed considerably between groups with a significantly higher number of lymphocytes (18% vs. 6.25%, P = 0.03) and a significantly lower number of neutrophils (25.9% vs. 58%, P = 0.02) in BMT BAL specimens. Atypical epithelial cells were significantly more frequent (75% vs. 30.8%, P = 0.027), and significantly more severe (P = 0.01) in BMT patients. The presence and severity of atypia was not associated with infection or pneumotoxic drug exposure (P = NS).
  
  
  CONCLUSIONS
  BAL cytology differs significantly between BMT and chemotherapy patients. The presence BAL lymphocytosis and severe epithelial cell atypia concomitantly to respiratory symptoms and GVHD in other organs may suggest the diagnosis of pulmonary GHVD. Prospective studies assessing the reliability of this finding combined with markers such as epithelial cell apoptosis and increased cytokines are needed.
authors.affiliation: Department of Child and Adolescent Medicine, Pediatric Pulmonology Unit, Hôpital des Enfants, Geneva, Switzerland. isabelle.rochat@hcuge.ch
authors.forename: I
authors.initials: I
authors.lastname: Rochat
authors.forename: K M
authors.initials: KM
authors.lastname: Posfay-Barbe
authors.forename: N
authors.initials: N
authors.lastname: Kumar
authors.forename: J-C
authors.initials: JC
authors.lastname: Pache
authors.forename: L
authors.initials: L
authors.lastname: Kaiser
authors.forename: H
authors.initials: H
authors.lastname: Ozsahin
authors.forename: C
authors.initials: C
authors.lastname: Barazzone Argiroffo
authors.forename: M
authors.initials: M
authors.lastname: Bongiovanni
mesh_terms: D000293:Adolescent; D015415:Biomarkers; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D002648:Child; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006086:Graft vs Host Disease / Q000473:pathology*; D006801:Humans; D008168:Lung / Q000473:pathology*; D008218:Lymphocytosis; D008297:Male; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers