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Cellular Composition of Bronchoalveolar Lavage Fluid in Patients with Hematologic Malignancies and Invasive Pulmonary Aspergillosis: Significant Associations with Peripheral Blood Cell Counts

Summary

Researchers studied lung fluid samples from cancer patients with a serious fungal lung infection called invasive pulmonary aspergillosis. They found that blood cell counts in the lungs correlated with blood cell counts overall, but surprisingly, the cell composition in lung fluid did not predict patient survival. The study highlights that doctors need better ways to assess the lung’s immune response to this serious fungal infection beyond just counting cells.

Background

Bronchoalveolar lavage (BAL) is frequently performed to diagnose invasive pulmonary aspergillosis (IPA) in patients with hematologic malignancies. The pulmonary immune environment plays a critical role in fungal control. However, data on concordance between peripheral blood and BAL fluid cell counts in IPA patients is lacking.

Objective

To evaluate the cellular composition of bronchoalveolar lavage fluid and its associations with peripheral blood cell counts, as well as its relationship with IPA outcomes in patients with hematologic malignancies.

Results

Median BALF WBC count was 129/µL with median neutrophil percentage of 11%. Peripheral blood total WBC counts significantly correlated with BALF WBC (r=0.55, p<0.001) and differentials. Neutropenic patients had lower BALF WBC and neutrophil counts. However, BALF cellular composition was not significantly associated with galactomannan positivity or 42-day mortality.

Conclusion

Peripheral blood cytopenias and coinfections significantly affected immune cell mobilization into BALF, but severity of IPA was not influenced by quantitative BAL cell composition. Qualitative/functional BAL biomarkers are needed to better prognosticate fungal control in hematologic malignancy patients.
  • Published in:Open Forum Infectious Diseases,
  • Study Type:Retrospective Cohort Study,
  • Source: 10.1093/ofid/ofae631.1205; PMID: PMC11777828
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