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A Comparison of Bronchoalveolar Lavage versus Lung Biopsy in Pediatric Recipients after Stem Cell Transplantation  Erin Qualter, Prakash Satwani, Angela.

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Presentation on theme: "A Comparison of Bronchoalveolar Lavage versus Lung Biopsy in Pediatric Recipients after Stem Cell Transplantation  Erin Qualter, Prakash Satwani, Angela."— Presentation transcript:

1 A Comparison of Bronchoalveolar Lavage versus Lung Biopsy in Pediatric Recipients after Stem Cell Transplantation  Erin Qualter, Prakash Satwani, Angela Ricci, Zhezhen Jin, Mark B. Geyer, Bachir Alobeid, Kavita Radhakrishnan, Michael Bye, William Middlesworth, Phyllis Della-Letta, Gerald Behr, Miguel Muniz, Carmella van de Ven, Lauren Harrison, Erin Morris, Mitchell S. Cairo  Biology of Blood and Marrow Transplantation  Volume 20, Issue 8, Pages (August 2014) DOI: /j.bbmt Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

2 Figure 1 (A) Diagnostic yield of bronchoaleolar lavage (BAL) versus lung biopsy (P < .0001). (B) Distribution of diagnosis after bronchoalveolar lavage (BAL) versus lung biopsy. Biology of Blood and Marrow Transplantation  , DOI: ( /j.bbmt ) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

3 Figure 2 (A) Patient with cytomegalovirus: chest CT with contrast shown in lung windows reveals interlobular septal thickening, ground glass opacification and a small right pleural effusion. Findings suggest diffuse lung disease but are not specific for 1 entity. (B) Patient with Mycobacterium Avium Intracellulare: noncontrast chest CT shown in lung windows reveals tree-in-bud opacities posteriorly in the right upper lobe. Similar opacities were seen throughout the lungs (not shown), particularly in the right middle lobe and lingula. The appearance and distribution suggests the presence of M. avium intracellulare. (C) Patient with parainfluenza 3: chest CT scan with contrast shown in lung windows reveals ground glass and mild confluent nodular opacities present posteriorly in the lungs bilaterally. Biology of Blood and Marrow Transplantation  , DOI: ( /j.bbmt ) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

4 Figure 3 (A) Lung biopsy section immunostained for herpes simplex virus (HSV)-1. Rare cells are positive, consistent with HSV infection. (B) Lung tissue section immunostained for cytomegalovirus (CMV). Positive cells are seen, consistent with CMV infection. (C). Lung tissue section immunostained for human parainfluenza virus (HPIV). Positive cells are seen, consistent with parainfluenza virus infection. (D) Lung tissue section. Numerous acid fast bacilli (AFB) are seen on AFB special stain, consistent with a mycobacterial infection. (E) Lung tissue section. Fungi (branched, septate hyphae), morphologically compatible with Aspergillus are identified with Gomori methenamine stain (GMS), consistent with Aspergillus infection. (F) Lung tissue section. A small airway shows scarring of the wall, associated lymphocytic inflammation involving the epithelium and wall of the airway, and rare apoptotic debris in the epithelium, consistent with pulmonary graft-versus-host disease (GVHD), causing obliterative bronchiolitis (constrictive bronchiolitis). (G) Lung tissue section immunostained for CD30. Multiple large Hodgkin cells are seen, consistent with recurrent classical Hodgkin lymphoma. (H) Lung tissue section. On trichrome special stain, diffuse, panlobular interstitial fibrosis is seen. Biology of Blood and Marrow Transplantation  , DOI: ( /j.bbmt ) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

5 Figure 4 (A) Probability of overall survival in pediatric HSCT recipients stratified for patients requiring bronchoalveolar lavage (BAL) versus no BAL/LB. (B) Probability of overall survival in pediatric HSCT recipients stratified for patients requiring lung biopsy versus no lung biopsy/bronchoalveolar lavage. Biology of Blood and Marrow Transplantation  , DOI: ( /j.bbmt ) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions


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