Early Versus Late Bronchoscopy in Bone Marrow Transplantation (BMT) Patients

At this time there exist no studies that help Pulmonologists and Oncologists decide on the
best time to perform diagnostic bronchoscopies in Bone Marrow Transplant patients with
suspected pulmonary infections. Practice patterns vary from institution to institution and
also vary widely within an institution based on the practice preferences of the attending
physicians. This study is a prospective randomized trial comparing early ( within 24-36
hours of enrollment) to late ( day 5-6 after enrollment) bronchoscopy in Bone Marrow
Transplant patients who develop pulmonary infiltrates or clinical evidence of respiratory
infection. If patients in the late arm require earlier bronchoscopy or do not require
bronchoscopy on day 5-6 then the care will be dictated by the attending physician. Only
bronchoscopies that are clinically indicated will be performed.

The aim is to determine the optimal timing for performing bronchoscopy in this group of
patients. The primary outcomes will be change of therapy as determined by addition or
removal of antibiotics, antifungals, antivirals or steroids etc. as well as the oncologist's
opinion on the impact the bronchoscopic results had on care of the patient. Patients will be
followed throughout their hospitalization as well as receive a phone call 3 months after
hospital discharge. Written consent will be obtained from the patients or health care power
of attorney in relevant cases.

It is our hope that the results of this study will help better define the role of
bronchoscopy in the management of Bone Marrow Transplant patients.

Inclusion Criteria:

- All patients who have had allogenic or autologous HSCT who are admitted to the BMT,
and felt to need bronchoscopy by their physician.

Exclusion Criteria:

- Active hemoptysis, allergies to topical and IV anesthetics with no appropriate
substitutes available. Being on non-invasive positive pressure ventilation that would
not allow for safe bronchoscopy.