UTILITY OF FIBEROPTIC BRONCHOSCOPY IN BONE-MARROW TRANSPLANT PATIENTS

Fiberoptic bronchoscopy (FOE) has been reported to have a high diagnos tic yield and to be safe in BMT patients with pulmonary infiltrates. A t our institution, BMT patients with respiratory symptoms and/or pulmo nary infiltrates had a thoracic CT and bronchoalveolar lavage (BAL), T ransbronchial biopsy (TBBx) was considered if the platelet count could be raised to >30x10(9)/l. From March 1993 to August 1995, 52 patients had 68 FOBs (42 BAL + TBBx, 26 BAL only) for 60 episodes of clinical pneumonia, Patients' characteristics were: 38 males, mean age 42 years , and 39 allogeneic BMTs. Of the 68 FOBs, 47 were performed to evaluat e diffuse infiltrates, 10 were done on mechanically ventilated patient s, and 50 of the FOBs were preceded by a platelet transfusion, Thirty- one percent of FOBs (21 FOBs, 19 patients) were diagnostic, Twenty-fou r percent of FOBs (11 diagnostic FOBs, six nondiagnostic FOBs) changed therapy, Ten complications (15%) occurred in 10 FOBs (five acute resp iratory failure, three pneumothoraces, one nose bleed, one death), Hos pital and 6-month survival based on episodes of clinical pneumonia wer e 47 and 32%, respectively, Patients who had a diagnostic FOE or a FOE that changed treatment did not have better hospital or 6-month surviv al compared to patients who had FOBs that were nondiagnostic or did no t change treatment, FOE in our BMT patient population, had a low diagn ostic yield (31%), infrequently changed treatment (24%), a significant complication rate (15%) and was not associated ,vith improved patient survival, The role of routine diagnostic FOE in BMT patients with pul monary infiltrates and/or respiratory symptoms should be reevaluated.