NYMC Faculty Publications

A Comparison of Bronchoalveolar Lavage versus Lung Biopsy in Pediatric Recipients After Stem Cell Transplantation

Erin Qualter, Department of Pediatrics, Columbia University, New York, New York.
Prakash Satwani, Department of Pediatrics, Columbia University, New York, New York.
Angela Ricci, Department of Pediatrics, Columbia University, New York, New York.
Zhezhen Jin, Department of Biostatistics, Columbia University, New York, New York.
Mark B. Geyer, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Bachir Alobeid, Department of Pathology and Cell Biology, Columbia University, New York, New York.
Kavita Radhakrishnan, Department of Pediatrics, Columbia University, New York, New York.
Michael Bye, Department of Pediatrics, Columbia University, New York, New York.
William Middlesworth, Department of Surgery, Columbia University, New York, New York.
Phyllis Della-Letta, Department of Pathology and Cell Biology, Columbia University, New York, New York.
Gerald Behr, Department of Radiology, Columbia University, New York, New York.
Miguel Muniz, Department of Pediatrics, New York Medical College, Valhalla, New York.
Carmella van de Ven, Department of Pediatrics, New York Medical College, Valhalla, New York.
Lauren Harrison, Department of Pediatrics, New York Medical College, Valhalla, New York.
Erin Morris, Department of Pediatrics, New York Medical College, Valhalla, New York.
Mitchell S. Cairo, Department of Pediatrics, New York Medical College, Valhalla, New York; Department of Medicine, New York Medical College, Valhalla, New York; Department of Pathology, New York Medical College, Valhalla, New York; Department of Microbiology and Immunology, New York Medical College, Valhalla, New York; Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York. Electronic address: Mitchell_cairo@nymc.edu.

Author Type(s)

Faculty

DOI

10.1016/j.bbmt.2014.04.019

Journal Title

Biology of Blood and Marrow Transplantation

First Page

1229

Last Page

37

Document Type

Article

Publication Date

8-1-2014

Abstract

Bronchoalveolar lavage (BAL) has been a useful initial diagnostic tool in the evaluation of pulmonary complications after hematopoietic stem cell transplantation (HSCT); however, the diagnostic sensitivity, prevalence, and outcome after BAL versus lung biopsy (LB) in pediatric HSCT patients remains to be determined. We reviewed 193 pediatric HSCT recipients who underwent a total of 235 HSCTs. Sixty-five patients (34%) underwent a total of 101 BALs for fever, respiratory distress, and/or pulmonary infiltrates on chest radiograph and/or computed tomography scan. The 1-year probability of undergoing BAL was 43.0% after allogeneic stem cell transplantation (alloSCT) and 8.5% after autologous stem cell transplantation (autoSCT) (P = .001). Sixteen of the 193 patients (8%) patients underwent 19 LBs. The probability of undergoing LB at 1 year after HSCT was 9.3%. No grade III or IV adverse events related to either procedure were observed. Of the 101 BALs performed, 40% (n = 40) were diagnostic, with a majority revealing a bacterial pathogen. Among the 19 LBs performed, 94% identified an etiology. In multivariate analysis, myeloablative conditioning alloSCT conferred the highest risk of requiring a BAL (hazard ratio [HR],8.5; P = .0002). The probability of 2-year overall survival was 20.2% in patients who underwent BAL, 17.5% for patients who underwent biopsy, and 67.4% for patients who had neither procedure. In multivariate analysis, only the requirement of a BAL was independently associated with an increased risk of mortality (HR, 2.96; P < .0001). In summary, in this cohort of pediatric HSCT recipients, BAL and LB were used in approximately 35% and 8% of pediatric HSCTs with diagnostic yields of approximately 40% and 94%, respectively, and were both associated with poor long-term outcomes.

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