Autologous Bone Marrow Transplantation - Blog Science Connections

Bronchoscopy in Marrow Transplantation 695
Table 1. Frequency of Abnormal Findings on Admission Chest X Ray,
Bronchoscopy, and Early Death in Patients Managed With High-Dose
Therapy and Autologous Hematopoietic Support
Diagnosis Therapy
No. of
Patients
Abnormal
Chest x ray
Abnormal
Findings on
Bronchoscopy
Lymphoma/CBV 14 6 12 2
Lymphoma/ACT 12 10 11 5
Solid tumor/Misc. 11 7 6 1
Early Death
(< 30 days)
Total 37 23 (62%) 28 (80%)" 8 (22%)"
Abbreviations: CBV, cyclophosphamide, BCNU (carmustine), VP-16-213
(etoposide) (6); ACT, arabinofuranosyl cytosine, cyclophosphamide, total body
irradiation (7).
a
No correlation between abnormal admission chest x ray and abnormal admission
bronchoscopic
findings.
b
No correlation between abnormal admission chest x ray or bronchoscopic findings
and early
death.
lavage at admission were, however, clinically useful. Abnormal visual findings
included clinically unsuspected upper-airway obstruction in three patients,
endobronchial tumor in three, extrinsic lower-airway obstruction in one
patient, and severe mucus plugging and bronchitis in one patient each.
The clinically significant findings in lavage fluid included abnormal cytologic
findings in nine patients, one of whom also had a positive culture for
Candida albicans. In addition, more than 15% neutrophils (indicating bronchitis)
was identified in bronchial washing from 14 patients and more than 5%
alveolar neutrophils (indicating alveolitis) in lavage fluid from 10 patients
(Table 2).
All eight patients who died during the period of marrow hypoplasia died
in pulmonary failure. The causes of death included Aspergillus in two patients,
Candida pneumonia in two, acute respiratory disease syndrome without
established etiology in two patients, and Pneumocystis carinii and combined
Table 2. Lavage Fluid Findings From Pretreatment Bronchoalveolar Lavage of
Patients In High-Dose Therapy
Normal 12(34%)
Abnormal cytology 9 (P. carinii, 2; yeast 4; bacteria, 3;
tumor cells, 1)
Abnormal culture
Bronchitis 14
Alveolitis 10
1 (C. albicans)