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Bronchoalveolar cytology for diagnosing pulmonary GVHD after bone marrow transplant in children
Author(s) -
Rochat I.,
PosfayBarbe K.M.,
Kumar N.,
Pache J.C.,
Kaiser L.,
Ozsahin H.,
Barazzone Argiroffo C.,
Bongiovanni M.
Publication year - 2008
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.20844
Subject(s) - medicine , bronchoalveolar lavage , chemotherapy , cytology , bone marrow , atypia , lymphocytosis , gastroenterology , pathology , respiratory disease , lung
Background Cytological composition of bronchoalveolar lavage (BAL) fluid in pediatric bone marrow transplant (BMT) recipients with pulmonary complications has not been comprehensively described and BAL specific markers of pulmonary GVHD are lacking. The aim of this retrospective study was to assess the role of BAL in the diagnosis of pulmonary GVHD by comparing BAL cytological findings between pediatric allogenic BMT patients with pulmonary complications and oncology children receiving chemotherapy alone. Methods Retrospective analysis of BAL specimens for cytology, total and differential cell counts and presence of infections. Results Seventeen BMT and 13 chemotherapy BAL were analyzed. BAL total cell count was increased but similar between groups (96.9 × 10 4 vs. 98.2 × 10 4 , P = NS). BAL cellular composition differed considerably between groups with a significantly higher number of lymphocytes (18% vs. 6.25%, P = 0.03) and a significantly lower number of neutrophils (25.9% vs. 58%, P = 0.02) in BMT BAL specimens. Atypical epithelial cells were significantly more frequent (75% vs. 30.8%, P = 0.027), and significantly more severe ( P = 0.01) in BMT patients. The presence and severity of atypia was not associated with infection or pneumotoxic drug exposure ( P = NS). Conclusion BAL cytology differs significantly between BMT and chemotherapy patients. The presence BAL lymphocytosis and severe epithelial cell atypia concomitantly to respiratory symptoms and GVHD in other organs may suggest the diagnosis of pulmonary GHVD. Prospective studies assessing the reliability of this finding combined with markers such as epithelial cell apoptosis and increased cytokines are needed. Pediatr Pulmonol. 2008; 43:697–702. © 2008 Wiley‐Liss, Inc.