Diagnostic Evaluation of Pulmonary Abnormalities in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation

Abstract

Pulmonary complications (PC) of hematologic malignancies and their treatments are common causes of morbidity and mortality. Early diagnosis is challenging due to host risk factors, clinical instability, and provider preference. Delayed diagnosis impairs targeted treatment and may contribute to poor outcomes. An integrated understanding of clinical risk and radiographic patterns informs a timely approach to diagnosis and treatment. There is little prospective evidence guiding optimal modality and timing of minimally invasive lung sampling; however, a low threshold for diagnostic bronchoscopy during the first 24 to 72 hours after presentation should be a guiding principle in high-risk patients.

A bronchoalveolar lavage‐driven antimicrobial treatment improves survival in hematologic malignancy patients with detected lung infiltrates: A prospective multicenter study of the SEIFEM group

“…Our diagnostic yield seems to be better than the other published data, but almost identical to those reported in the few prospective studies with a similar design . In our study, the BAL results allowed guiding the on‐going empirical treatment in about 60% of cases, according to the data reported in the literature that are more heterogeneous but reported an overall percentage between 20 and 70% . We showed a significantly better clinical outcome in terms of response to antimicrobial treatment, 120d‐OS (78% vs 59%; P = .009) and 120d‐AM (11% vs 30%; P = .003) for patients in which a BAL‐driven antimicrobial treatment was possible.…”

“…In 10 cases, a mixed infection was diagnosed. Our diagnostic yield seems to be better than the other published data, but almost identical to those reported in the few prospective studies with a similar design . In our study, the BAL results allowed guiding the on‐going empirical treatment in about 60% of cases, according to the data reported in the literature that are more heterogeneous but reported an overall percentage between 20 and 70% .…”

“…Detection of lung infiltrates (LI) is a relevant concern in patients with hematologic malignancy (HM), occurring in about 12%‐15% of severely neutropenic patients and significantly affecting survival . Moreover, infectious, and less frequently non‐infectious LI occur in up to 70% and 25% of patients, respectively, undergoing allogeneic hematopoietic stem cell transplant (alloSCT) and autologous hematopoietic stem cell transplant (ASCT).…”

“…Moreover, microbiologically undiagnosed LI may reflect a deferred diagnostic approach. Clinicians prefer to adopt an empirical treatment strategy, and use more invasive approaches only in cases of persistence of fever, and when there is an appearance or worsening of respiratory distress . In case of LI of undefined etiology, bronchoscopy coupled with bronchoalveolar lavage (BAL) are used to diagnose putative microbiological agents, in order to perform guided‐antimicrobial therapy.…”

A Comparison of Aspergillus and Mucorales PCR Testing of Different Bronchoalveolar Lavage Fluid Fractions from Patients with Suspected Invasive Pulmonary Fungal Disease

“…However, this demand might be hard to achieve in the daily clinical routine. In a study by Harris and Geyer, the time from the time of detection of lung infiltrates to the time of bronchoscopy was a median of 3 days (range, 1 to 13 days), despite the fact that positive yields from BALF are the greatest when bronchoscopy is performed within the first 24 h of presentation (19).…”