Between January 1998 and July 2003, 345 patients, 233 adults and 112 children, were treated with allogeneic SCT at Huddinge University Hospital. Pneumonia was diagnosed in 136 patients, 91 adults and 45 children, with either chest x-ray (82%) or CT (18%). At the time of diagnosis, all patients had respiratory symptoms and/or increased C-reactive protein and temperature. In 90 patients with pneumonia was BAL not performed. The most common reason was a poor general condition (33%) and early administration of therapy (24%) resulting in clinical improvement. Thirty-two (36%) of these 90 patients died due to pneumonia. Fifty-one BAL was performed in 46 patients median 5 (1-24) months after SCT. At the time of BAL, 8 patients had a poor respiratory function with low pO2. However, no severe adverse effects of BAL were diagnosed. The median time between radiographic diagnosis and BAL was 2 (1-46) days. Sixteen (35%) of 46 patients died due to pneumonia after BAL. In 21 cases, 6 without treatment at the time of BAL, BAL showed only negative findings. However, in 7 cases, BAL was performed median 15 (10-46) days after pneumonia was diagnosed and in 7 cases, patients were already administered broad spectrum antibiotics and/or anti-fungal therapy at the time of BAL. In another three patients with negative findings, obstructive bronchiolitis was diagnosed in two and sarkoidosis in one patient. Five patients with negative findings died of pneumonia. In 30 (59%) of 51 BAL performed, potentially pathogenic organisms were isolated. In 12 of 30 cases, patients had not been given broad spectrum antibiotics and/or anti-fungal therapy at the time of BAL. Altogehter, 24 organisms were identified. In 12 patients, two potentially pathogenic organisms were identified and in 4 patients three pathogenic organisms were detected. The most common identified organisms were: CMV (8), aspergillus (5), Candida Glabrata (4), EBV (3), adeno (3), RS-virus (2) and pneumocystis carinii (2). Eleven patients with positive findings of BAL died. The most common cause of death was CMV (4) and aspergillus (3). In conclusion, in this retrospective study BAL proved to be a safe diagnostic tool which should be performed earlier and more oftenly in the onset of pneumonia after allogeneic SCT.
Full conference title:
30th Annual Meeting of the European Group for Blood and Marrow Transplantation
- EBMT 2004