Ghandili Susanne, von Kroge Philipp H, Simon Marcel, Henes Frank O, Rohde Holger, Hoffmann Armin, Lindeman Nick Benjamin, Bokemeyer Carsten, Fiedler Walter, Modemann Franziska
Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Cancers (Basel). 2022 Jun 2;14(11):2773. doi: 10.3390/cancers14112773.
Despite therapeutic advances in the prevention and treatment of febrile neutropenia, acute leukemia (AL) patients still have considerable febrile neutropenia-related mortality. However, the diagnostic yield of flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) in acute leukemia patients is unclear. In this retrospective single-center study, we analyzed 88 BAL samples of patients with acute leukemia and pulmonary infiltrates in spite of treatment with broad-spectrum anti-infective agents. The aim was to investigate the impact of FB with BAL on detecting causative organisms, which would result in a change in treatment regimens. The median age was 59 years, and 86% had acute myeloid leukemia. In 47%, pathogens were detectable in BAL fluid (pathogen bacteria, viruses, and fungi in 2, 15, and 18%, respectively), with detected most frequently. BAL-guided anti-infective therapy changes were performed in 15%. The detection of herpes simplex and influenza viruses were the main reasons for treatment changes. Despite broad-spectrum anti-infective treatment, in approximately half of all patients, pathogens could still be isolated in BAL samples. However, consecutive changes in anti-infective treatment were considerably less frequent, with most changes performed in patients with and detection. The need for FB with BAL in patients with AL receiving broad-spectrum empiric anti-infective treatment should therefore be weighed carefully.
尽管在发热性中性粒细胞减少症的预防和治疗方面取得了治疗进展，但急性白血病（AL）患者仍有相当高的与发热性中性粒细胞减少症相关的死亡率。然而，急性白血病患者中柔性支气管镜检查（FB）和支气管肺泡灌洗（BAL）的诊断率尚不清楚。在这项回顾性单中心研究中，我们分析了88例尽管接受了广谱抗感染药物治疗但仍有肺部浸润的急性白血病患者的BAL样本。目的是研究FB联合BAL对检测致病微生物的影响，这可能会导致治疗方案的改变。中位年龄为59岁，86%的患者患有急性髓系白血病。在47%的患者中，BAL液中可检测到病原体（分别有2%、15%和18%的患者检测到病原菌、病毒和真菌），其中 检测最为频繁。15%的患者根据BAL结果进行了抗感染治疗的调整。单纯疱疹病毒和流感病毒的检测是治疗调整的主要原因。尽管进行了广谱抗感染治疗，但在所有患者中约有一半，BAL样本中仍可分离出病原体。然而，抗感染治疗的连续调整频率要低得多，大多数调整是在检测到 和 的患者中进行的。因此，对于接受广谱经验性抗感染治疗的AL患者，是否需要进行FB联合BAL应仔细权衡。
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