Safety and Benefits of Bronchoalveolar Lavage and Lung Biopsy in the Management of Pulmonary Infiltrates in Children With Leukemia

Elbahlawan, Lama; Avent, Yvonne; Montoya, Libby; Wilder, Keith; Pei, Deqing; Cheng, Cheng; Morrison, R. Ray; Jeha, Sima

doi:10.1097/mph.0000000000000644

Cited by 13 publications

(8 citation statements)

References 11 publications

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“…At St. Jude, patients with suspected PCP or with unexplained respiratory illness refractory to standard therapy typically undergo bronchoalveolar lavage to identify the presence of pneumocystis. During the study period, PCR gradually replaced immunofluorescence as the predominant test of PCP (21). Potential PCP cases were identified by the review of patient EMRs, ICD-9 codes (136.3), pharmacy and pathology records, and death summaries.…”

Section: Methodsmentioning

confidence: 99%

Pentamidine for Prophylaxis against Pneumocystis jirovecii Pneumonia in Pediatric Oncology Patients Receiving Immunosuppressive Chemotherapy

Quinn

Fannin

Sciasci

et al. 2018

Antimicrob Agents Chemother

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pneumonia is a life-threatening opportunistic infection in children receiving immunosuppressive chemotherapy. Without prophylaxis, up to 25% of pediatric oncology patients receiving chemotherapy will develop pneumonia. Trimethoprim-sulfamethoxazole is the preferred agent for prophylaxis against pneumonia. Pentamidine may be an acceptable alternative for pediatric patients unable to tolerate trimethoprim-sulfamethoxazole. A retrospective review was conducted of pediatric oncology patients who received ≥1 dose of pentamidine for pneumonia prophylaxis between January 2007 and August 2014. Electronic medical records were reviewed to determine the incidence of breakthrough pneumonia or discontinuation of pentamidine associated with adverse events. A total of 754 patients received pentamidine prophylaxis during the period. There were no cases of probable or proven pneumonia, and 4 cases (0.5%) of possible pneumonia. The incidence of possible breakthrough pneumonia was not significantly different between subgroups based on age (<12 months [1.7%] versus ≥12 months [0.4%], = 0.3), route of administration (aerosolized [0%] versus intravenous [1.0%], = 0.2), or hematopoietic stem cell transplant status (transplant [0.4%] versus no transplant [0.8%], = 0.6). Pentamidine was discontinued due to an adverse drug event in 23 children (3.1%), more frequently for aerosolized than for intravenous administration (7.6% versus 2.2%, respectively, = 0.004). Intravenous or inhaled pentamidine may be a safe and effective second-line alternative for prophylaxis against pneumonia in children with cancer receiving immunosuppressive chemotherapy or hematopoietic stem cell transplantation.

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Section: Methodsmentioning

confidence: 99%

Pentamidine for Prophylaxis against Pneumocystis jirovecii Pneumonia in Pediatric Oncology Patients Receiving Immunosuppressive Chemotherapy

Quinn

Fannin

Sciasci

et al. 2018

Antimicrob Agents Chemother

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“…Antimicrobial coverage was changed in more than 83% of patients. Approximately 38% of patients who underwent BAL had complications, the most common of which was hypoxia ( 38 ). Prior studies report changes in antimicrobial management after BAL ( 37 – 39 ) but won’t comment on prognosis and survival except for three studies in which positive and negative BAL results prompted antimicrobial changes ( 1 , 40 ) but failed to show improvement in survival ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Retrospective Review of Flexible Bronchoscopy in Pediatric Cancer Patients

et al. 2021

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The use of flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) to diagnose and manage pulmonary complications has been shown to be safe in adult cancer patients, but whether its use is safe in pediatric cancer patients remains unclear. Thus, to describe the landscape of FB outcomes in pediatric cancer patients and to help define the populations most likely to benefit from the procedure, we undertook a retrospective review of FBs performed in patients younger than 21 years treated at our institution from 2002 to 2017. We found that a greater volume of total fluid instilled during BAL was significantly associated with increased probabilities of positive BAL culture (p=0.042), positive bacterial BAL culture (p=0.037), and positive viral BAL culture (p=0.0496). In more than half of the FB cases, findings resulted in alterations in antimicrobial treatment. Our study suggests that for pediatric cancer patients, FB is safe, likely provides diagnostic and/or therapeutic benefits, and has implications for treatment decisions.

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“…Which procedure gives the most helpful diagnostic information with the lowest complication rate remains to be answered. Many studies have compared both procedures in immunocompromised children but found no consensus on the superiority of one procedure ( 30 , 50 ). In a study that compared BAL to lung biopsy in a pediatric cohort post-HCT, the diagnostic yield of BAL was 40% compared to 94% with lung biopsy.…”

Section: Bal Versus Lung Biopsymentioning

confidence: 99%

Pulmonary Complications in Children Following Hematopoietic Cell Transplantation: A Case Report and Review of the Diagnostic Approach

et al. 2021

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Pulmonary complications are common in children following hematopoietic cell transplantation (HCT) and contribute to their morbidity and mortality. Early diagnosis is essential for management and prevention of progression of lung injury and damage. In many cases, diagnosis can be challenging and may require diagnostic imaging and more invasive testing such as bronchoscopy and lung biopsy. We report the case of a 12-year-old girl who developed recurrent episodes of acute respiratory failure requiring intensive care unit admission in the post-HCT phase and describe the diagnostic and multidisciplinary approach for her management. In addition, we review the diagnostic approach of pulmonary complications post-HCT and highlight the utility and risks of bronchoscopy and lung biopsy in these children.

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Safety and Benefits of Bronchoalveolar Lavage and Lung Biopsy in the Management of Pulmonary Infiltrates in Children With Leukemia

Cited by 13 publications

References 11 publications

Pentamidine for Prophylaxis against Pneumocystis jirovecii Pneumonia in Pediatric Oncology Patients Receiving Immunosuppressive Chemotherapy

Pentamidine for Prophylaxis against Pneumocystis jirovecii Pneumonia in Pediatric Oncology Patients Receiving Immunosuppressive Chemotherapy

Retrospective Review of Flexible Bronchoscopy in Pediatric Cancer Patients

Pulmonary Complications in Children Following Hematopoietic Cell Transplantation: A Case Report and Review of the Diagnostic Approach

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