Flexible bronchoscopy in the diagnosis of pulmonary infiltrates following autologous peripheral stem cell transplantation for advanced breast cancer

Abstract

Summary:Flexible bronchoscopy is an important tool in the diagnosis of pulmonary complications following bone marrow transplantation. However, the value of this procedure in autologous peripheral stem cell transplant (APSCT) recipients with pulmonary complications is not well defined. We retrospectively evaluated the diagnostic yield of 27 consecutive bronchoscopies done on 23 APSCT recipients following high-dose chemotherapy for breast cancer. FB resulted in a positive diagnosis in 16 cases (59%). Broncheoalveolar lavage (BAL) was performed on all patients, and transbronchial biopsies (TBB) were carried out in 14. TBB were diagnostic in 10 (71%), with pulmonary drug toxicity as the most common finding (n ‫؍‬ 8), followed by metastatic breast cancer (n ‫؍‬ 2). BAL was diagnostic in six (22%): bacterial pneumonia (n ‫؍‬ 3), aspergillosis (n ‫؍‬ 2), Pneumocystis carinii pneumonia (n ‫؍‬ 1) and Influenza B (n ‫؍‬ 1). The procedure was well tolerated with no major complications except a small pneumothorax in one patient that did not require chest tube insertion. In conclusion, flexible bronchoscopy is a useful tool in the evaluation of pulmonary complications following APSCT for breast cancer. TBB can be done safely with relatively high diagnostic yield. Pulmonary drug toxicity is the most common pathological finding. Bone Marrow Transplantation ( nant and nonmalignant disorders. Pulmonary complications are estimated to be in the range of 40-60%, and are a major cause of morbidity and mortality in these patients. 1-3Recently, there has been a growing interest in the use of high-dose chemotherapy (HDC) followed by autologous peripheral stem cell transplantation (APSCT) for the treatment of a variety of conditions, especially advanced breast cancer, lymphoma and brain tumors as well as nonmalignant conditions like scleroderma. [4][5][6] Pulmonary complications are generally less frequent and less severe following APSCT when compared to allogeneic BMT, mainly due to less immunosuppression and absence of graft-versus-host disease. However, recent reports indicate that pulmonary drug toxicity is a major complication of APSCT, and this is primarily related to the use of carmustine (BCNU), which is central to different HDC regimens. 7Pulmonary drug toxicity is commonly diagnosed and treated based on clinical grounds. However, there are situations where the clinical picture is not clear, and there is suspicion of infection or cancer recurrence, or the patient does not respond well to corticosteroids. In these situations further invasive procedures, including flexible bronchoscopy (FB) are usually necessary. Although the role of FB in the evaluation of pulmonary infiltrates following BMT in general, has been studied extensively, 8,9 its role in patients with pulmonary complications following HDC and APSCT is not well studied. Accordingly, we retrospectively studied the bronchoscopic findings in all patients who underwent FB for evaluation of pulmonary problems following HDC and APSCT for the treatment of advanced breast canc...

Retrospective utility of bronchoscopy after hematopoietic stem cell transplant

“…The study by Glazer et al 7 showed the highest yield, but this may be explained in part because they did not include any information on their prophylactic antiinfective regimen, they did not document what criteria were used to establish a diagnosis of bacterial pneumonia and they diagnosed idiopathic pneumonia syndrome from histologic features which are not standard. Soubani et al 32 reported an unusually high yield from transbronchial biopsies, but this likely resulted from a retrospective review of only metastatic breast cancer patients who had received autografts conditioned with BCNU and cyclophosphamide, biasing the yield to drug toxicity or recurrent cancer. 33,34 There are a number of limitations to our retrospective study.…”

Pulmonary complications following hematopoietic stem cell transplantation: Diagnostic approaches

“…(39% auto) Gruson [98] 2000 NR 49% BAL Soubani [59] 2001 Autologous 59% BAL +TBBX Feinstein [60] 2001 Allogeneic 42% BAL + TBBX specific yield for infection in this series was 67% (10 of 15 TTNAs), which was comparable to bronchoscopy. Complications were observed in 18 of 71 patients (25%), with pneumothorax occurring in 14 patients (20%) and 4 patients (6%) requiring chest tube placement.…”

“…Soubani and co-workers reviewed 27 bronchoscopies and transbronchial biopsies (TBBX) in breast cancer patients who underwent HSCT [59]. The most common causes of lung lesions were pulmonary drug toxicity (47%), bacterial infection (17%), and IPA (11%).…”

Diagnostic Value of Bronchoalveolar Lavage in Leukemic and Bone Marrow Transplant Patients: The Impact of Antimicrobial Therapy

“…The reported diagnostic yield of BAL in immunocompromised patients, including those with HIV or solid organ transplant, with pulmonary infiltrates ranges widely from 22 to 80%. [5][6][7][8][9] Studies of BAL sensitivity in hematopoietic stem cell transplant (HSCT) patients report yields of 22-65%. 6,7,[9][10][11][12] With respect to the yield of BAL in non-resolving pneumonia one study in the general intensive care unit (ICU) setting, Pereira Gomes reported a 72% yield in 53 patients.…”

“…[5][6][7][8][9] Studies of BAL sensitivity in hematopoietic stem cell transplant (HSCT) patients report yields of 22-65%. 6,7,[9][10][11][12] With respect to the yield of BAL in non-resolving pneumonia one study in the general intensive care unit (ICU) setting, Pereira Gomes reported a 72% yield in 53 patients. 13 We sought to examine the effect of antimicrobial treatment on BAL results in a large study population of leukemic and bone marrow transplant patients.…”