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Bronchoalveolar Lavage in the Diagnosis of Pulmonary Infiltrates in Patients with Acute Leukemia
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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Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients: Guidelines of the infectious diseases working party of the German Society of Haematology and Oncology
2009, European Journal of CancerCitation Excerpt :Microbiological diagnosis is based on blood cultures, sputum and endoscopically obtained bronchial secretions or bronchoalveolar lavage (BAL) fluid. The diagnostic yield of these procedures is controversially debated.26,69–77 Unselected samples obtained from neutropenic cancer patients with ‘pneumonia’ showed a predominance of microorganisms without aetiological relevance,78 while autopsy results demonstrate that in the majority of patients who died from invasive fungal infection, diagnosis has not been established ante mortem.79
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2009, Clinical Mycology with CD-ROMBronchoscopic diagnosis of pulmonary infiltrates in granulocytopenic patients with hematologic malignancies: BAL versus PSB and PBAL
2007, Respiratory MedicineCitation Excerpt :Various bronchoscopic techniques, such as BAL, PSB and PBAL, have been used in patients with hematologic diseases and were compared in this study. The sensitivity of BAL to diagnose the cause of pulmonary infiltrates in these patients from 15% to 66%.13,14,16,18,19 In the present study, the diagnostic yield of BAL (26%) was superior to PSB (14%) and PBAL (14%) individually, however the results of the combination of both protected procedures was almost identical to that of BAL.
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Manuscript received February 15, revision accepted March 24