Fiberoptic Bronchoscopy (FOB) in Hematopoietic Stem Cell Transplant (HSCT) and Leukemia Patients With Acute Respiratory Symptoms and Pulmonary Infiltrates

• Diagnostic Yield [ Time Frame: 30 days ] [ Designated as safety issue: No ]
  1.1 To determine the diagnostic yield related to fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) in hematopoietic stem cell transplant (HSCT) and leukemia patients with acute respiratory symptoms and pulmonary infiltrates utilizing both current standard of care microbiology testing and emerging molecular genetic laboratory assessments.
  
  

• Comparison of diagnostic yield to historical data [ Time Frame: 30 days ] [ Designated as safety issue: No ]
  To compare the diagnostic yield using the combination of standard of care microbiology testing and emerging molecular genetic microbiology polymersase chain reaction (PCR)/assay testing to our prospectively collected historical data obtained at our institution.
  
  
• Therapeutic changes from BAL [ Time Frame: 30 days ] [ Designated as safety issue: No ]
  To document therapeutic changes that occurred as a result of FOB findings
  
  
• Correlation of infiltrates with microbiological findings [ Time Frame: 30 days ] [ Designated as safety issue: No ]
  To correlate specific types of pulmonary infiltrates (focal, multifocal, or diffuse interstitial or alveolar infiltrates) with microbiological findings
  
  
• Description of microbiological findings [ Time Frame: 24-48 hours ] [ Designated as safety issue: No ]
  To describe the microbiological findings in HSCT and leukemia patients with fever, respiratory symptoms, and pulmonary infiltrates
  
  
• Comparison of new testing vs standard of care tests [ Time Frame: 30 days ] [ Designated as safety issue: No ]
  To compare the findings of the new PCR-based tests to that of current standard of care tests.
  
  

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.