Prognostic factors in bronchoalveolar lavage in 77 patients with bone marrow transplants

To study the prognostic implications of the following factors in bronchoalveolar lavage (BAL) specimens in bone marrow transplant (BMT) patients: number of lymphocytes per high-power field (HPF), presence of hemosiderin-laden macrophages (HLMs), presence of infections and presence of reactive epithelial cellular changes in bronchial and alveolar cells.

A retrospective study of 77 bone marrow transplant patients who required BAL. Each specimen was studied for the number of lymphocytes per HPF, presence of HLMs, presence of infection and presence of reactive epithelial cells.

Patients who had < or = 5 lymphocytes per HPF had a much higher death rate than did patients who had > 5 lymphocytes per HPF (P < .001). Eighty-nine percent of patients who had < or = 5 lymphocytes per HPF died within 30 days of undergoing BAL (P < .001). Patients without HLMs had a better prognosis than did patients with HLMs (P < .005). Thirty-six documented viral or fungal infections occurred in 33 patients. Patients with infections had a greater chance of dying than did those who were infection free (P < .05). Multiple logistic regression analysis showed that the previous three factors are statistically significant. Reactive epithelial cellular changes were seen primarily in patients with autologous BMT (11 of 14 cases) and in those with hematologic malignancies, but they had no statistical significance prognostically.

The following factors in BAL have a good prognostic value: number of lymphocytes > 5 per HPF, absence of HLMs and absence of infections. Reactive epithelial cellular changes have no prognostic value.