Fiberoptic bronchoscopy in allogeneic bone marrow transplantation - Findings in the era of serum cytomegalovirus antigen surveillance

Study objectives: Pulmonary complications occur in half of allogeneic bone marrow transplantation (BMT) patients. The incidence of these complications has been reduced by prophylaxis against Pneumocystis carinii pneumonia, pr eemptive therapy in patients at high risk for cytomegalovirus (CMV) reactiv ation, and, more recently, screening for serum CMV antigen. Since fiberopti c bronchoscopy (FOB) has historically been the primary diagnostic test to e valuate BMT patients with pulmonary disease, a review was performed to dete rmine the impact, if any, that current prophylaxis and screening policies m ay have had on FOB utility. Design: The records of 174 adult patients undergoing BMT between January 19 97 and December 1999 were reviewed to determine the diagnostic yield of FOB and the frequency by which FOB altered management. Results: Sixty-one patients underwent 76 bronchoscopies. FOB was diagnostic in 32 patients (42.1% of cases) and directly changed management in 24 pati ents (31.6% of cases). Half of these changes included the withdrawal of an antimicrobial agent. The most common findings were infection (32 cases) and diffuse alveolar hemorrhage (6 cases). CMV was the most prevalent infectio n identified, but FOB resulted in the addition of antiviral therapy to only two patients. P carinii pneumonia was not diagnosed in any patient studied . Conclusions: These data suggest a changing spectrum of pulmonary disease in BMT patients. FOB has limited impact on the diagnoses of CMV disease or P carinii pneumonia with current prophylaxis and screening strategies. It may be useful in identifying other infectious etiologies and in eliminating un necessary antimicrobials.