Fiberoptic Bronchoscopy (FOB) in Hematopoietic Stem Cell Transplant (HSCT) and Leukemia Patients With Acute Respiratory Symptoms and Pulmonary Infiltrates
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Blood Cancer, Pulmonary |
| Therapuetic Areas: | Oncology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - 80 |
| Updated: | 7/8/2016 |
| Start Date: | March 2011 |
| End Date: | December 2016 |
A Prospective Assessment of the Diagnostic Utility of Emerging Laboratory Assessments Used in Conjunction With Fiberoptic Bronchoscopy (FOB) in Hematopoietic Stem Cell Transplant (HSCT) and Leukemia Patients With Acute Respiratory Symptoms and Pulmonary Infiltrates
Pulmonary infiltrates frequently complicate the care of hematopoietic stem cell transplant
(HSCT) and leukemia patients. Bronchoalveolar lavage (BAL) is frequently used to evaluate
new pulmonary infiltrates in this population, however utility is limited by a historically
low diagnostic yield for infection.
In an effort to improve diagnostic yields, this study will complete a Fiberoptic
Bronchoscopy (FOB) within 8 hours of radiographic documentation of pulmonary infiltrates,
prior to initiating new antibiotic therapy. To further improve detection of microbiological
pathogens, the study will utilize PCR testing with rapid turnaround time to detect atypical
pneumonia (M pneumoniae, C. Pneumonia, Legionella species, and respiratory viruses) and
aspergillosis.
(HSCT) and leukemia patients. Bronchoalveolar lavage (BAL) is frequently used to evaluate
new pulmonary infiltrates in this population, however utility is limited by a historically
low diagnostic yield for infection.
In an effort to improve diagnostic yields, this study will complete a Fiberoptic
Bronchoscopy (FOB) within 8 hours of radiographic documentation of pulmonary infiltrates,
prior to initiating new antibiotic therapy. To further improve detection of microbiological
pathogens, the study will utilize PCR testing with rapid turnaround time to detect atypical
pneumonia (M pneumoniae, C. Pneumonia, Legionella species, and respiratory viruses) and
aspergillosis.
Proper diagnosis and prompt treatment favorably impacts survival in the post transplant
setting, but is often difficult and frequently results in inappropriate or late therapy. Low
yields may be linked with empiric antibody therapy begun prior to the procedure, delayed
time to procedure, procedure technique, the presence of graft versus host disease (GVHD),
neutropenia, and diffuse infiltrates (as opposed to localized infiltrates or focal masses
and nodules). One recent study found that early FOBs (less than or equal to 4 days between
detection of pulmonary infiltrates and FOB) were 2.5 times more likely to establish a
diagnosis of pneumonia compared to late examinations. Delaying this procedure(greater than 5
days between detection of pulmonary infiltrates and FOB) was associated with drug resistant
organisms, polymicrobial infections, and worsened patient prognosis.
setting, but is often difficult and frequently results in inappropriate or late therapy. Low
yields may be linked with empiric antibody therapy begun prior to the procedure, delayed
time to procedure, procedure technique, the presence of graft versus host disease (GVHD),
neutropenia, and diffuse infiltrates (as opposed to localized infiltrates or focal masses
and nodules). One recent study found that early FOBs (less than or equal to 4 days between
detection of pulmonary infiltrates and FOB) were 2.5 times more likely to establish a
diagnosis of pneumonia compared to late examinations. Delaying this procedure(greater than 5
days between detection of pulmonary infiltrates and FOB) was associated with drug resistant
organisms, polymicrobial infections, and worsened patient prognosis.
Inclusion Criteria:
- Autologous or allogeneic stem cell patients with new acute respiratory symptoms or
pulmonary infiltrates
- leukemia patients with new acute respiratory symptoms or pulmonary infiltrates
thought to be unrelated to disease
Exclusion Criteria:
- Patients unwilling to undergo FOB
- Patients unable to undergo FOB due to clinical status
- Patients unable to undergo FOB within 8 hours of radiographic report of pneumonia
- Patients unable to wait until completion of FOB to implement antibiotic changes
- Adults unable to provide informed consent
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Northside Hospital Northside Hospital-Atlanta (in Sandy Springs) opened in 1970. The original facility had 250...
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