Bronchoalveolar lavage cell composition in allogeneic bone marrow transplant patients without symptomatic lung complications

Abstract

Summary:that it is similar to that seen in healthy volunteers is not based on solid data. Only a few articles have included a small group of asymptomatic BMT patients as a comparaThe purpose of this study was to assess the cytological composition of bronchoalveolar lavage (BAL) fluid in tive or control group. [1][2][3][4][5][6] Observations in healthy individuals have contributed to define the inflammatory and immune allogeneic BMT patients without lung complications and compare it with that obtained from healthy volunteers.responses of the normal lung and have provided a basis for the study of lung disease. 7 In this way, in the BMT setting During the first 6 months post-BMT we studied the differential cell counts of 98 BALs from 56 patients as well knowledge of what is normal after transplantation could enhance our understanding of the different post-transplant as the total cell count of 44 BALs from 27 patients. The BAL cellular composition in BMT patients was clearly lung complications and provide keys to improving treatment or prevention; it might also be used as 'the normal different from that of healthy subjects: there was a marked increase in alveolar neutrophils (in 82% of the reference' for comparison in pathologic conditions. The purpose of this study was to investigate the cytological patients when sequential BALs were performed) and an increase in lymphocytes, with a lower percentage of composition of BAL fluid in a group of asymptomatic allogeneic BMT patients and compare it with that obtained macrophages and similar numbers of eosinophils. A greater variation in cellular populations was found from a group of healthy volunteers. We found quite marked differences between both groups as well as a striking inciwithout an evident cause. The total number of cells per ml of fluid recovered appeared similar to that of healthy dence of asymptomatic neutrophilic alveolitis. volunteers. A high frequency of neutrophilic alveolitis was found in patients with asymptomatic CMV on BAL. Owing to the variability of BAL cellular composition in Material and methods asymptomatic BMT patients and its difference from that in healthy volunteers, great caution should be taken Study population when interpreting the BAL composition data from patients with lung complications. In order to avoid Sequential BAL were performed in consecutive patients who had received an allogeneic BMT from May 1991 to drawing wrong conclusions these data should be compared with those obtained from a control group of BMT November 1995 in the BMT unit of the Hematology Department. BALs were carried out electively as part of a patients without lung complications and not from healthy volunteers.previously described CMV surveillance protocol 8 which has been adopted in our BMT unit as a routine method Keywords: bone marrow transplantation; bronchoalveolar lavage; BAL cellularity since 1991. All BALs were done for CMV surveillance and not for the study of any pulmonary or respiratory disease. The day of BMT was considered as day 0. In summary, the fir...

TNFα, interleukin-10 and interleukin-18 expression in cells of the bronchoalveolar lavage in patients with pulmonary complications following bone marrow or peripheral stem cell transplantation: a preliminary study

“…These data agree with previous reports but it has to be taken into account that in a study by de la Camara et al 7 …”

“…[2][3][4][5] BAL cytology after BMT/PBSCT has not been studied extensively and information about the presence of pro-and antiinflammatory cytokines in this compartment is sparse. [6][7][8][9] Previous studies have investigated cytokine patterns in serum and peripheral blood cells after BMT/PBSCT in case of infection and GVHD. [10][11][12] GVHD is characterized by activation of Th1 subsets of CD4 + helper cells resulting in interleukin-2 production.…”

Lung function and airway inflammation monitoring after hematopoietic stem cell transplantation

“…It was shown to be useful in the assessment of chronic lung rejection after lung transplantation [9] but it has never been studied in patients undergoing HSCT. A previous study has shown that bronchoalveolar lavage neutrophil counts increased during the first 6 months after HSCT in patients without overt pulmonary complications [10]. Similarly, fraction of exhaled nitric oxide (FeNO), a non-invasive marker of airway inflammation, has been used to monitor lung transplantation rejection [11] but its utility has been poorly assessed after HSCT.…”

The safety and usefulness of routine bronchoscopy before stem cell transplantation and during neutropenia

“…3,4 Its use as a research or surveillance tool must therefore be based on clear evidence of its safety. Most reports of BAL in transplant recipients without respiratory impairment imply acceptable safety without detailing complications, 5,7,[9][10][11][12][13] and where rates are quoted they are low (eg 2% 14 ). The subjects of these reports were not neutropenic.…”