Safety and Value of Bronchoalveolar Lavage and Lung Biopsy in Children with Leukemia: A Single Institution Experience.

Abstract 2153

Patients with hematological malignancies are at risk of developing life threatening opportunistic pulmonary infections. The value of bronchoalveolar lavage (BAL) and lung biopsy (BX) in the management of these patients is debatable. While some believe these procedures are relatively safe and often provide valuable information that can guide management in these patients, others question the benefit of the procedures or are concerned about the potential complications of the procedures. We reviewed the St Jude experience with bronchoalveolar lavage and lung biopsy in children with leukemia to assess the benefit and safety of these 2 procedures. Review of medical records from January 1, 1997 through December 31, 2007 identified 183 potential episodes of BAL or BX in patients with leukemia who were younger than 22 years at time of procedure. In 30 patients who had multiple procedures, only the initial procedure was included.

A total of 64 patients were included, 36 (56.3%) of which had lung biopsy and 28 (43.7%) who had BAL. (See Table 1 for Demographics). There was a trend of better yield with BAL as compared to BX (67% versus 44%, p=0.079). Better BAL yield was observed in: males versus females (88% versus 42%, p=0.017), ALL versus AML (79% versus 44%, p=0.097), non-neutropenic versus neutropenic children (90% versus 56%, p=0.098). Both procedures resulted in change in antimicrobial coverage (78% in lung biopsy, 89% in BAL). Although both procedures were relatively safe, patients with BX had more complications as compared to BAL. Bx resulted in new oxygen need in 4 patients, increased oxygen need in 1 patient, intubation in 2 patients, and bleeding in 1 patient. BAL resulted in new oxygen need in 2 patients and increase in need in 7 patients, but no intubation or bleeding was related to this procedure.

In summary, BAL and BX have a reasonable safety profile and contributed to the management of pulmonary infections in children with leukemia. Compared to BX, BAL was associated with higher yields and less complications.