Background Children with leukemia are at risk of developing life threatening opportunistic pulmonary infections. The role of bronchoalveolar lavage (BAL) and lung biopsy (BX) in the management of these patients is controversial. In this study, we evaluate the yield and safety of BAL and BX in children with leukemia. Procedure We reviewed the records of all children with leukemia who underwent either BAL or BX between 1997 and 2007 at the St Jude Children’s Research Hospital. Results A total of 64 patients were included, of whom 35 (55%) had BX and 29 (45%) had BAL. Positive results were obtained in 69% of BAL cohort and in 46% of BX cohort. Both procedures resulted in change in antimicrobial coverage (77% in lung biopsy, 83% in BAL). Pulmonary hemorrhage occurred in 2 patients, and transient hypoxia was the most frequent complication. All resolved without negatively impacting the clinical course. Conclusion Both BAL and BX are safe and useful in the management of children with leukemia and pulmonary disease.

Respiratory syncytial virus (RSV) is associated with adverse outcomes among immunocompromised patients. Inhaled ribavirin has been shown to improve mortality rates. The Small-Particle Aerosol Generator delivery system (SPAG-2) is the only FDA-cleared device to deliver inhaled ribavirin. However, it is difficult to set up and maintain. We developed a method for delivery of this medication using the vibrating mesh nebulizer (Aerogen®). We did not observe any adverse events with this method.

Respiratory syncytial virus (RSV) is associated with adverse outcomes among immunocompromised patients. Inhaled ribavirin has been shown to improve mortality rates. The Small-Particle Aerosol Generator delivery system (SPAG-2) is the only FDA-cleared device to deliver inhaled ribavirin. However, it is difficult to set up and maintain. We developed a method for delivery of this medication using the vibrating mesh nebulizer (Aerogen®). We did not observe any adverse events with this method.

2153 Patients with hematological malignancies are at risk of developing life threatening opportunistic pulmonary infections. The value of bronchoalveolar lavage (BAL) and lung biopsy (BX) in the management of these patients is debatable. While some believe these procedures are relatively safe and often provide valuable information that can guide management in these patients, others question the benefit of the procedures or are concerned about the potential complications of the procedures. We reviewed the St Jude experience with bronchoalveolar lavage and lung biopsy in children with leukemia to assess the benefit and safety of these 2 procedures. Review of medical records from January 1, 1997 through December 31, 2007 identified 183 potential episodes of BAL or BX in patients with leukemia who were younger than 22 years at time of procedure. In 30 patients who had multiple procedures, only the initial procedure was included. A total of 64 patients were included, 36 (56.3%) of which had lung biopsy and 28 (43.7%) who had BAL. (See Table 1 for Demographics). There was a trend of better yield with BAL as compared to BX (67% versus 44%, p=0.079). Better BAL yield was observed in: males versus females (88% versus 42%, p=0.017), ALL versus AML (79% versus 44%, p=0.097), non-neutropenic versus neutropenic children (90% versus 56%, p=0.098). Both procedures resulted in change in antimicrobial coverage (78% in lung biopsy, 89% in BAL). Although both procedures were relatively safe, patients with BX had more complications as compared to BAL. Bx resulted in new oxygen need in 4 patients, increased oxygen need in 1 patient, intubation in 2 patients, and bleeding in 1 patient. BAL resulted in new oxygen need in 2 patients and increase in need in 7 patients, but no intubation or bleeding was related to this procedure. In summary, BAL and BX have a reasonable safety profile and contributed to the management of pulmonary infections in children with leukemia. Compared to BX, BAL was associated with higher yields and less complications. Table 1. Demographics Variable BAL (28) BX (36) Sex M/F 16/12 19/17 Mean Age 11 years 11 years ALL patients 19 12 AML patients 9 24 Neutropenia (ANC≤500) 18 21 Intubated prior to procedure 13 4 Disclosures: No relevant conflicts of interest to declare.