Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient

Immunosuppressed oncology patients who develop pulmonary infiltrates during treatment have a mortality rate of the order of 55-90%, Early diagnosis an d treatment is associated with increased survival. At present, diagnosis re lies on invasive sampling of the respiratory tract using fibre-optic bronch oscopy. We have looked at a 30-month period, from June 1997 to December 199 9, where 25 bronchoscopies were performed on patients from the Lymphoma and BMT units at The Royal Marsden Hospital for the further investigation of p ulmonary infiltrates. Nine bronchoscopies (36%) yielded a positive result a nd seven (28%) led to a change in management. Analysis of the data showed t hat neither a positive result nor a change in management had any impact on overall survival. After reviewing the background literature on the investig ation of pulmonary infiltrates in this group and discussion of the respecti ve merits and limitations, we propose a management flowchart, with high-res olution computed tomography (HRCT) as the test arm in a future randomised t rial of these patients.