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.