Diagnostic open-lung biopsy after bone marrow transplantation

Area of Science:

• Pulmonology
• Oncology
• Transplantation Medicine

Background:

• Pulmonary infiltrates are a serious complication in immunocompromised hosts (ICH).
• Diagnostic decisions for ICH require balancing risks and benefits of procedures like bronchoscopy and open-lung biopsy (OLB).
• Bone marrow transplantation (BMT) recipients are particularly vulnerable to pulmonary complications.

Purpose of the Study:

• To evaluate the diagnostic yield and therapeutic impact of open-lung biopsy (OLB) in pediatric bone marrow transplantation (BMT) recipients.
• To assess the frequency of therapeutic changes resulting from OLB findings.
• To determine the clinical outcomes following OLB-directed therapy.

Main Methods:

• Retrospective chart review of 87 BMT recipients who underwent diagnostic OLB between 1975 and 1986.
• Analysis of bronchoscopic and OLB cultures, histopathology, serology, and autopsy data.
• Assessment of therapeutic alterations and clinical changes post-OLB.

Main Results:

• Ninety-four OLBs were performed in 87 patients, most commonly after leukemia or aplastic anemia treatment.
• Sixty percent of OLBs provided a specific diagnosis for pulmonary infiltrates.
• Minor postoperative complications occurred in 21% of patients, with a 45% 30-day postoperative mortality rate.

Conclusions:

• Open-lung biopsy (OLB) can provide specific diagnoses for pulmonary infiltrates in immunocompromised hosts, including bone marrow transplant recipients.
• Despite diagnostic utility, OLB is associated with substantial morbidity and mortality in this high-risk population.
• The risk-benefit profile of OLB must be carefully considered in the management of pulmonary infiltrates in immunocompromised patients.