Role of Invasive Procedures in the Diagnosis and Management of Pulmonary Infiltrates in Patients with Leukemia

Kim, Chang Ho; Jung, Tae Hoon; Park, Jae Yong; Kang, Tae Kyong; Cha, Seung Lck; Chae, Sang Chul

Abstract

BACKGROUND: Pulmonary infiltrate is a frequent cause of morbidity and mortality in patients with leukemia. It is often hard to obtain a reliable diagnosis by clinical and radiologic findings alone. The aim of this study was to evaluate diagnostic and therapeutic benefits of invasive procedures as for for new lung infiltrates in leukemia.
METHODS
Patients with leukemia who developed new lung infiltrates from December 1994 to March 1999 were included in this study. These patients were classified into the empirical group who received empirical therapy only and into the invasive group who underwent bronchoscopy or surgical lung biopsy for the diagnostic purpose of new lung infiltrates. Retrospective A retroactive chart review was done to search for find the etiologies of new lung infiltrates, the yield of invasive procedures, outcome as well as predicting factors for survival of patients.
RESULTS
1) One hundred-two episodes of new lung infiltrates developed in 90 patients with leukemia. Invasive procedure was performed in 44 episodes while 58 episodes were treated with empirical therapy only. 2) Invasive procedures yielded a specific diagnosis in 72.7%(32/44)(,) of which 78.1% had infectious etiology. Therapeutic plan was changed in 52.3%(23/44) of patients after invasive procedures. None of them showed procedure-related mortality. 3) Overall The overall survival rate was 62.7%(64/102). Survival rate in the invasive group(79.5%) was significantly better than that in the empirical group (50.0%) (p=0.002). 4) On multivariate analysis, Upon multivariate analysis, the performance of invasive procedures, no need for mechanical ventilation and achievement of complete remission of leukemia after induction chemotherapy were the independent factors predicting predicting factors for survival in patients with leukemia and new lung infiltrates.
CONCLUSION
Bronchoscopy and surgical lung biopsy are useful in the diagnosis of new lung infiltrates in patients with leukemia. However, survival benefits of invasive procedures should be considered together with disease status of leukemia and severity of respiratory compromise.