Chest
Volume 94, Issue 4, October 1988, Pages 745-749
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Bronchoalveolar Lavage in the Diagnosis of Pulmonary Infiltrates in Patients with Acute Leukemia

https://doi.org/10.1378/chest.94.4.745Get rights and content

The utility of bronchoalveolar lavage (BAL) in determining the causative agent of pulmonary infiltrates in patients with acute leukemia is not known. We retrospectively evaluated the diagnostic yield of BAL in 22 adults with acute leukemia and compared the results with those at autopsy performed within three weeks of BAL. All patients had neutropenia and thrombocytopenia at the time of BAL, were receiving broad-spectrum antibacterial agents, and 15 were also receiving amphotericin B before BAL. The median interval between the detection of pulmonary infiltrates and BAL was seven days (range, 0 to 23 days); the median interval between BAL and autopsy was nine days (range, 1 to 20 days). The diagnostic yield of BAL was 15 percent (3 of 20 specific diseases); all three were Candida pneumonia. The sensitivity of BAL was 75 percent and its specificity 100 percent, for Candida pneumonia. BAL did not result in a specific diagnosis for the 17 remaining diseases, nine of which were Aspergillus pneumonia. In seven patients in whom autopsy was performed within 72 hours of BAL, lavage results correlated with those of autopsy in only one who had Candida pneumonia. All BAL cultures were falsely positive, except in four cases of Candida pneumonia. The therapeutic regimen was not modified according to the BAL results in any of the 22 patients. There were no major complications associated with the procedure. (Chest 1988; 94:745-49)

Section snippets

MATERIALS AND METHODS

We reviewed the medical records of all adults with acute leukemia cared for at the University of Texas M. D. Anderson Hospital and Tumor Institute between October 1984 and January 1987 and examined by BAL for pulmonary infiltrates. Patients were included only if they met the following criteria: (1) a diagnosis of acute leukemia or chronic myelogenous leukemia (CML) in the terminal phase being treated with intensive chemotherapy; (2) a neutrophil count of less than 1,000/μl at the time of BAL;

RESULTS

The clinical characteristics of the 22 patients who met our inclusion criteria are shown in Table 1. There were ten men and 12 women, who had a median age of 55 years (range, 20 to 81 years). Underlying diseases were acute nonlymphocytic leukemia (ten patients), acute lymphocytic leukemia (seven patients), and CML in blastic transformation (four patients) and in accelerated phase (one patient). Four patients had received antileukemic chemotherapy and total body irradiation followed by

DISCUSSION

In our study BAL had a low diagnostic yield (15 percent, 3/20 specific diseases) for pulmonary infiltrates in a subset of adults with acute leukemia, fever, profound neutropenia, and pulmonary infiltrates suggestive of multiple processes. This low yield was particularly striking among patients with pulmonary aspergillosis. These results contrast with findings of previous studies,18, 19, 20, 21 which reported higher diagnostic yields of BAL in immunocompromised patients without AIDS. There are,

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    Manuscript received February 15, revision accepted March 24

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