■患有血液系统恶性肿瘤和干细胞移植的患者经常发生肺部并发症。不管支气管肺泡灌洗(BAL)的微生物学用途,关于其作为治疗决策指南的益处及其对患者临床结果的影响的信息很少。
■在2011年7月至2016年7月之间进行了一项前瞻性观察性单中心研究。在18岁以上的血液系统恶性肿瘤并接受化学疗法或干细胞移植的受试者中分析了肺浸润的连续发作。
■分析了96次肺浸润。急性白血病是最常见的潜在疾病。37例患者(38.5%)接受了干细胞移植。在纳入研究时,有61例(62.9%)为中性粒细胞减少症。41例(42.7%)获得明确的病因诊断,感染占绝大多数病例(33例,80.5%)。13例(13.5%)通过非侵入性方法获得了明确诊断。47例进行了BAL,并导致40.4%的病例诊断。BAL结果导致27例(57.4%)的治疗改变,包括在10个经验性治疗中添加新的抗菌药物。关于BAL的安全,2例患者出现轻微不良事件,1例出现严重不良事件;未观察到手术相关死亡.
■感染是血液系统恶性肿瘤和干细胞移植患者肺部浸润的主要原因。BAL是一个有用的决策诊断工具,轻微不良事件。
UNASSIGNED: Pulmonary complications are frequent in patients with hematologic malignancies and stem cell transplantation. Regardless of the microbiological usefulness of bronchoalveolar lavage (BAL), little information exists on both its benefits as a guide for therapeutic decisions and its impact on patients\' clinical outcome.
UNASSIGNED: A prospective observational single-center study was performed between July 2011 and July 2016. Consecutive episodes of pulmonary infiltrates were analyzed in subjects over 18 years of age who presented hematologic malignancies and underwent chemotherapy or stem cell transplantation.
UNASSIGNED: Ninety-six episodes of pulmonary infiltrates were analyzed. Acute leukemia was the most frequent underlying condition. Thirty-seven patients (38.5%) received a stem cell transplant. Sixty-one (62.9%) were neutropenic at the moment of inclusion in the study. A definitive etiologic diagnosis was obtained in 41 cases (42.7%), where infection accounted for the vast majority of cases (33 cases, 80.5%). Definitive diagnosis was reached by non-invasive methods in 13 cases (13.5%). BAL was performed in 47 cases and led to a diagnosis in 40.4% of the cases. BAL results led to therapeutic changes in 27 cases (57.4%), including the addition of new antimicrobials to empiric treatments in 10. Regarding BAL\'s safety, two patients experienced minor adverse events and one a severe adverse event; no procedure-related deaths were observed.
UNASSIGNED: Infection was the leading cause of pulmonary infiltrates in patients with hematologic malignancies and stem cell transplantation. BAL was a useful decision-making diagnostic tool, with minor adverse events.