Utility of flexible bronchoscopy with polymerase chain reaction in the diagnosis and management of pulmonary infiltrates in allogeneic HSCT patients.

OBJECTIVES: Pulmonary infiltrates in allogeneic hematopoietic stem cell transplant (allo-HSCT) patients are potentially life-threatening and require early diagnosis and treatment. We aimed to retrospectively explore the clinical efficacy of polymerase chain reaction (PCR) in conjunction with flexible bronchoscopy (FB) in allo-HSCT patients with pulmonary infiltrates.

PATIENTS AND METHODS: We retrospectively reviewed all patients undergoing FB after allo-HSCT at the Peking University Institute of Hematology from January 2013 to December 2016. We used PCR to detect various viruses in FB specimens, particularly for 27 viruses.

RESULTS: One hundred forty-nine diagnostic FBs were performed in 130 patients. The overall diagnostic yield was 58%. Eighty-nine percent of the patients with a positive FB result were diagnosed with a pulmonary infection. Viruses were the most common infectious diagnosis (70%), followed by fungi (48%), bacteria (38%), and Pneumocystis jirovecii (12%). Multivariate analyses showed that a chest computed tomography (CT) finding of diffuse pulmonary infiltrates (P = .012) and positive results in assisted microbiological and serological analyses (P = .000) predicted a positive FB result. FB results prompted a treatment modification in 61% of cases.

CONCLUSIONS: FB in conjunction with PCR is efficient in the rapid diagnosis and management of pulmonary infiltrates in allo-HSCT patients.