Abstract Introduction Flexible bronchoscopy and bronchoalveolar lavage (BAL) are useful tools for assessing for lower airway infection that may not be evident by clinical symptoms or routine chest imaging. In patients undergoing bone marrow transplant (BMT), identification and treatment of infection prior to beginning immunosuppression is paramount in ensuring successful engraftment and patient survival. The utility of flexible bronchoscopy in pre-transplant evaluation has been poorly described in children; a systematic review by Gonski et al found that BAL results changed management in 53% of pediatric patients with pulmonary lesions or symptoms; however, there remains a paucity of literature regarding the utility of routine bronchoscopy for infectious screening prior to transplant. Materials And Methods All pediatric patients from our institution who underwent BMT from 2020-2023 were screened. Those who underwent bronchoscopy as part of their pre-BMT screening were selected, with special attention to chest imaging findings and presence/absence of respiratory symptoms. Bronchoscopy findings - including anatomic, infectious and cytologic - were reviewed. Delay in transplant, oxygen requirement and overall survival were used to assess outcomes. Results A total of 270 patients underwent BMT from 2020-2023, with 90% of patients being 18yo. Of these, 78 underwent bronchoscopy for pre-transplant screening, the majority of whom had known immunodeficiency, respiratory symptoms or suspicious findings on chest imaging. Twenty-two of these patients had acute or chronic cough, with 10 (45%) having positive viral or bacterial testing on BAL. Similarly, 14 patients had chest imaging findings concerning for active infection, with 6 (43%) having positive testing on BAL. Fifty-five patients (70%) were asymptomatic; of these, 12 (22%) had positive testing on BAL. Three patients required delay in transplant, one of which was due to new finding of trachea-esophageal fistula. Post-transplant, the majority of patients (75%) remained on room air/nasal cannula, 9% required HFNC/NIPPV, 11% required mechanical ventilation and 1 patient required ECMO. The 1-year survival was 80%. Conclusions This retrospective study highlights a rigorous approach to infectious screening in a high-risk pediatric population. Our results suggest that BAL yield remains low in asymptomatic patients with negative chest imaging but provides higher yield in symptomatic individuals or those with abnormal imaging, consistent with prior studies. However, the majority of positive BAL findings were viral in nature and did not change acute management or affect transplant timing. For this reason, bronchoscopy should only be considered as an adjunct to pre-BMT infectious screening in patients with high clinical suspicion. This abstract is funded by: None
Muruato et al. (Fri,) studied this question.