Autologous Bone Marrow Transplantation - Blog Science Connections

696 Bronchoscopy in Marrow Transplantation
Candida and Aspergillus pneumonia in one patient each. Only one of these
diseases was seen in the initial bronchoscopic examination and bronchoalveolar
lavage, in a patient who, at admission, had very low numbers of P. carlmi
that were not recognized initially but were identified upon review. In this
patient and the others who died, the etiology of their pulmonary dysfunction
was identified by subsequent bronchoscopy and bronchoalveolar lavage, and
none required an open-lung biopsy. Autopsies performed on all eight patients
confirmed that there was no additional pulmonary pathology.
DISCUSSION
Patients referred for high-dose therapy with autologous hematopoietic
support, at least in the early days of this therapy, were patients in a significantly
immunocompromised state and with altered intrathoracic anatomy before
treatment. In this population, a high incidence of clinically significant findings
was identified by admission bronchoscopic examination and bronchoalveolar
lavage. Many of these findings mandated clinical interventions that
undoubtedly decreased the ultimate morbidity and mortality of the high-dose
therapy and subsequent marrow aplasia. However, pulmonary failure
remains the major proximate cause of death in this patient population, and
repeated bronchoscopic examination with bronchoalveolar lavage is necessary
to determine the etiology of significant changes in the patient's clinical
course. No significant morbidity and mortality were associated with the pretreatment
bronchial examination methods used in this patient population.
Subsequent bronchoscopic exam and bronchoalveolar lavage, performed
when the patients' clinical situation has deteriorated, do carry a higher risk,
which may be avoided in many cases by vigorous response to findings of the
pretreatment studies.
Based on the results reported in this chapter, we have continued to perform
routine pretreatment bronchoscopic examinations and bronchoalveolar
lavage in patients being managed in our institution with high-dose therapy
and autologous hematopoietic support.
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