A comparison of bronchoalveolar lavage versus lung biopsy in pediatric recipients after stem cell transplantation.
Bronchoalveolar lavage (BAL) has been a useful initial diagnostic tool in the evaluation of pulmonary complications after hematopoietic stem cell transplantation (HSCT); however, the diagnostic sensitivity, prevalence, and outcome after BAL versus lung biopsy (LB) in pediatric HSCT patients remains to be determined. We reviewed 193 pediatric HSCT recipients who underwent a total of 235 HSCTs. Sixty-five patients (34%) underwent a total of 101 BALs for fever, respiratory distress, and/or pulmonary infiltrates on chest radiograph and/or computed tomography scan. The 1-year probability of undergoing BAL was 43.0% after allogeneic stem cell transplantation (alloSCT) and 8.5% after autologous stem cell transplantation (autoSCT) (P = .001). Sixteen of the 193 patients (8%) patients underwent 19 LBs. The probability of undergoing LB at 1 year after HSCT was 9.3%. No grade III or IV adverse events related to either procedure were observed. Of the 101 BALs performed, 40% (n = 40) were diagnostic, with a majority revealing a bacterial pathogen. Among the 19 LBs performed, 94% identified an etiology. In multivariate analysis, myeloablative conditioning alloSCT conferred the highest risk of requiring a BAL (hazard ratio [HR],8.5; P = .0002). The probability of 2-year overall survival was 20.2% in patients who underwent BAL, 17.5% for patients who underwent biopsy, and 67.4% for patients who had neither procedure. In multivariate analysis, only the requirement of a BAL was independently associated with an increased risk of mortality (HR, 2.96; P < .0001). In summary, in this cohort of pediatric HSCT recipients, BAL and LB were used in approximately 35% and 8% of pediatric HSCTs with diagnostic yields of approximately 40% and 94%, respectively, and were both associated with poor long-term outcomes.
Department of Pediatrics, Columbia University, New York, New York.
Erin
E
Qualter
Department of Pediatrics, Columbia University, New York, New York.
Prakash
P
Satwani
Department of Pediatrics, Columbia University, New York, New York.
Angela
A
Ricci
Department of Biostatistics, Columbia University, New York, New York.
Zhezhen
Z
Jin
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Mark B
MB
Geyer
Department of Pathology and Cell Biology, Columbia University, New York, New York.
Bachir
B
Alobeid
Department of Pediatrics, Columbia University, New York, New York.
Kavita
K
Radhakrishnan
Department of Pediatrics, Columbia University, New York, New York.
Michael
M
Bye
Department of Surgery, Columbia University, New York, New York.
William
W
Middlesworth
Department of Pathology and Cell Biology, Columbia University, New York, New York.
Phyllis
P
Della-Letta
Department of Radiology, Columbia University, New York, New York.
Gerald
G
Behr
Department of Pediatrics, New York Medical College, Valhalla, New York.
Miguel
M
Muniz
Department of Pediatrics, New York Medical College, Valhalla, New York.
Carmella
C
van de Ven
Department of Pediatrics, New York Medical College, Valhalla, New York.
Lauren
L
Harrison
Department of Pediatrics, New York Medical College, Valhalla, New York.
Erin
E
Morris
Department of Pediatrics, New York Medical College, Valhalla, New York; Department of Medicine, New York Medical College, Valhalla, New York; Department of Pathology, New York Medical College, Valhalla, New York; Department of Microbiology and Immunology, New York Medical College, Valhalla, New York; Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York. Electronic address: Mitchell_cairo@nymc.edu.
Mitchell S
MS
Cairo
D000293:Adolescent; D018893:Bronchoalveolar Lavage / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000601:surgery* / Q000628:therapy*; D008297:Male; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014184:Transplantation, Homologous / Q000009:adverse effects*
Bronchalveolar lavage; Lung biopsy; Pediatrics; Stem cell transplantation