DIAGNOSTIC PERFORMANCE AND SAFETY OF BRONCHOALVEOLAR LAVAGE IN THROMBOCYTOPENIC HAEMATOLOGICAL PATIENTS FOR ASPERGILLOSIS DIAGNOSIS: A MONOCENTRIC, RETROSPECTIVE EXPERIENCE.

DIAGNOSTIC PERFORMANCE AND SAFETY OF BRONCHOALVEOLAR LAVAGE IN THROMBOCYTOPENIC HAEMATOLOGICAL PATIENTS FOR ASPERGILLOSIS DIAGNOSIS: A MONOCENTRIC, RETROSPECTIVE EXPERIENCE.

Background: although bronchoalveolar lavage (BAL) measurements of galactomannan antigen (GM) seems to be more sensitive than serum testing to detect invasive pulmonary aspergillosis (IPA), a consensus on the most appropriate diagnostic threshold of the BAL GM test is still unclear. Moreover, there i...

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Main Authors: Mariagiovanna Cefalo, Ermanno Puxeddu, Loredana Sarmati, giovangiacinto paterno, Carla Fontana, Daniela Nassa, Gloria Pane, Eleonora De Bellis, Raffaele Palmieri, Elisa Buzzatti, Federico Meconi, Roberta Laureana, Paola Casciani, Anna Giulia Zizzari, Paola Rogliani, Paolo de Fabritiis, Luca Maurillo, Francesco Buccisano, Maria Cantonetti, William Arcese, Adriano Venditti, Maria Ilaria Del Principe
Format: Article
Language:English
Published: PAGEPress Publications 2019-10-01
Series:Mediterranean Journal of Hematology and Infectious Diseases
Subjects:
bronchoalveolar lavage, galactomannan antigen, pulmonary aspergillosis, hematologic malignancies, thrombocytopenia
Online Access:http://mjhid.org/index.php/mjhid/article/view/4030
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Summary:Background: although bronchoalveolar lavage (BAL) measurements of galactomannan antigen (GM) seems to be more sensitive than serum testing to detect invasive pulmonary aspergillosis (IPA), a consensus on the most appropriate diagnostic threshold of the BAL GM test is still unclear. Moreover, there is uncertainty as to whether BAL is a safe procedure in patients with hematological malignancies (HM) and thrombocytopenia (TC). Objectives: based on this background, 102 adult patients with HM and associated thrombocytopenia were retrospectively analyzed with the twin aims of 1) determining whether BAL is a safe and feasible procedure; and, 2) identifying the most appropriate threshold for GM positivity  in the diagnosis of IPA. Patients/Methods: each BAL was considered as one case/patient. One hundred twelve BALs were carried out in 102 HM patients: at the time of the BAL, the median platelets count (PLTs) in all patients was 47x109/L (1-476) and 31 patients (27%) had PLTs< 20x109/L. Results: complications from the BAL were infrequent (3.5%) and mild. No bleeding was reported. The BAL GM cut off of >0.8 was associated with the best diagnostic accuracy (sensitivity 72.97% and specificity 80%). Antifungal treatment of patients with BAL GM >0.8resulted in  a clinical-radiological improvement in 35/41patients (85%). Conclusions: BAL was a safe procedure also in thrombocytopenic patients, permitting an IPA diagnosis not otherwise identifiable using  EORTC/MSG criteria. Our data suggest that a BAL GM value of>0.8 represents the most useful cut-off in terms of sensibility and specificity. Further prospective studies on a larger number of patients are needed to confirm these results.
ISSN:2035-3006

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