Role of Fiberoptic Bronchoscopy in Decision-Making in the Management of Post-Hematopoietic Stem Cell Transplant Patients Presenting with Pulmonary Infiltrates: A Retrospective Cohort Study.

Background: The role of fiberoptic bronchoscopy (FOB) in the management of patients presenting with pulmonary infiltrates after hematopoietic stem cell transplant (HSCT) remains unclear. We aimed to evaluate the diagnostic value and safety of FOB at our center.

Methods: This retrospective study included all patients with post-HSCT pulmonary infiltrates who underwent FOB between 2016 and 2019. The demographic, clinical, interventional, microbiological, and histological data and changes in management and the 6-month outcome were recorded.

Results: A total of 86 consecutive HSCT recipients were included. The median patient age was 34 years (range: 14-67), 53 patients (61.6%) were males. The median interval between symptom onset and FOB was 7 days (IQR: 2-17). FOB yielded a positive result in 53 patients (61.6%). The pathogen was a virus, bacteria, fungus in 29 (33.7%), 19 (22.1%), and 11 (12.8%) patients, respectively. The treatment was modified in 52 patients (60.5%) according to the FOB result. An imaging finding of "tree-in-bud" was associated with a positive FOB yield (p = 0.05). The timing of bronchoscopy (<4 vs. ≥5 days), graft-versus-host disease, neutropenia, and antimicrobial use had no significant effect (p > 0.05). No serious complications were encountered.

Conclusion: FOB led to changes in management in over half of the patients. Delay up to 1 week after presentation and empirical antimicrobials did not have any effect on the yield. FOB is a safe diagnostic tool in the post-HSCT patients with pulmonary infiltrates.