title: Bronchoalveolar lavage cellular patterns in monoclonal antibody-induced lung disease.
abstract: BACKGROUND
  The increase in the use of monoclonal antibodies (mAB) as a targeted therapy for a variety of diseases has been accompanied by an increase in reports of interstitial lung abnormalities in treated patients.
  
  
  OBJECTIVE
  Bronchoalveolar lavage (BAL) is routinely performed in these patients to rule out infection, so we sought to determine the BAL cellular pattern in individuals with mAB-induced lung disease (mAB-ILD).
  
  
  METHODS
  We utilized a case-control study design. Among patients treated with mAB, cases were defined as those with otherwise-unexplained interstitial lung abnormalities, which resolved after cessation of treatment, while controls were defined as those with interstitial abnormalities clearly explained by other etiologies.
  
  
  RESULTS
  From 2000 to 2012, we identified 9 cases and 7 controls. The mean age of the cases was 62.6 ± 26 years and 6 were female. The most common radiographic finding was diffuse ground-glass opacities. The most common BAL cellular pattern was mixed inflammation with moderate lymphocytic and mild neutrophilic alveolitis. The cases had a higher mean lymphocyte count than the controls (40.1 ± 32.6 vs. 13.1 ± 25.5, p = 0.008). The rest of the BAL cellular analyses were similar between the 2 groups. The median CD4:CD8 ratio in 7 patients with >15% lymphocytes was 0.9 (0.6-3). There was no significant difference in the CD4:CD8 ratio between the 2 groups.
  
  
  CONCLUSIONS
  Mixed inflammation with moderate lymphocytic and mild neutrophilic alveolitis is the most common BAL cellular pattern in patients with mAB-ILD. Such findings may be useful for the early identification of mAB-ILD.
authors.affiliation: Pulmonary-Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Ind., USA.
authors.forename: Shikha
authors.initials: S
authors.lastname: Gupta
authors.forename: Patricia
authors.initials: P
authors.lastname: Smith
authors.forename: Homer L
authors.initials: HL
authors.lastname: Twigg Iii
authors.forename: Chadi A
authors.initials: CA
authors.lastname: Hage
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology* / Q000276:immunology; D016516:CD4-CD8 Ratio; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced / Q000276:immunology*; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology* / Q000276:immunology; D012189:Retrospective Studies
chemical_list: D000911:Antibodies, Monoclonal