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Value of bronchoalveolar lavage before haematopoietic stem cell transplantation for primary immunodeficiency or autoimmune diseases

Lookup NU author(s): Dr Mary Slatter, Elizabeth Rogerson, Claire Taylor, Dr Angela Galloway, Dr Clark Clark, Dr Terence Flood, Dr Mario Abinun, Professor Andrew Cant, Professor Andrew GenneryORCiD

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Abstract

Pulmonary infection, often insidious, is frequent in primary immunodeficiency (PID) and acquired immunodeficiency. Pulmonary complications are serious obstacles to success of haematopoietic SCT (HSCT) for these conditions. Bronchoalveolar lavage (BAL) permits identification of lower respiratory tract pathogens that may direct specific treatment and influence prognosis. There are no reports about the utility of pre-HSCT BAL for immunodeficient patients. We prospectively studied the value of 'routine' BAL before commencing transplantation in patients undergoing HSCT for severe immunological disease. Routine non-bronchoscopic BAL was performed under general anaesthetic, a few days before commencing pre-HSCT cytoreductive chemotherapy. Patients were categorized as symptomatic or asymptomatic with respect to pulmonary disease or infection. Samples were sent for microbiological processing. Complications arising from the procedure, pathogens isolated and treatments instituted were recorded. Results were available from 69-75 patients transplanted during the study period; 26 (38%) had pathogens identified (six asymptomatic patients), 10 (14.5%) developed complications post-procedure (two asymptomatic patients) - all recovered, 21 had management changes. There was no statistically significant difference in the number of positive isolates from severe combined or other immunodeficient patients, or of symptomatic or asymptomatic patients. Routine non-bronchoscopic BAL is safe in immunodeficient patients about to undergo HSCT, and leads to management changes.


Publication metadata

Author(s): Slatter MA, Rogerson EJ, Taylor CE, Galloway A, Clark JE, Flood TJ, Abinun M, Cant AJ, Gennery AR

Publication type: Article

Publication status: Published

Journal: Bone Marrow Transplantation

Year: 2007

Volume: 40

Issue: 6

Pages: 529-533

Print publication date: 01/09/2007

ISSN (print): 0268-3369

ISSN (electronic): 1476-5365

Publisher: Nature Publishing Group

URL: http://dx.doi.org/10.1038/sj.bmt.1705776

DOI: 10.1038/sj.bmt.1705776

PubMed id: 17637688


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