INVESTIGATION AND MANAGEMENT OF PULMONARY-INFILTRATES FOLLOWING BONE-MARROW TRANSPLANTATION - A 8 YEAR REVIEW

Background-Although pulmonary infiltrates are common in bone marrow tr ansplant recipients and add significantly to the morbidity and mortali ty of this group of patients, there is uncertainty as to the most appr opriate investigation and a lack of information on the effects of inve stigations on management and outcome. Methods-All bone marrow transpla nt recipients from one institution referred for respiratory investigat ion between 1982 and 1990 were reviewed. Results-Of 204 bone marrow tr ansplant recipients 27 developed pulmonary infiltrates which failed to respond to broad spectrum antibiotics. All were examined by bronchosc opy and bronchoalveolar lavage. A specific diagnosis was made in 20 ca ses, 17 with an infective cause and three with a non-infective aetiolo gy. In 17 of the 27 episodes these investigations led to a positive ch ange in treatment, but in only five did these changes result in patien t survival beyond one month. Eighteen of the 20 deaths were due to pro gressive respiratory failure of an infective aetiology in 14 and non-i nfective in four. Conclusions-Bronchoscopy and bronchoalveolar lavage are effective in establishing a diagnosis, but the impact on overall s urvival is disappointingly poor.