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Bronchiectasis in Hematologic Malignancy FREE TO VIEW

Pamela McShane, MD; Neel Patel, MD; Heber MacMahon, MB; Mary Strek, MD; Edward Naureckas, MD
Chest. 2011;140(4_MeetingAbstracts):458A. doi:10.1378/chest.1115438
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PURPOSE: Bronchiectasis is a rarely described complication of hematologic malignancy, the etiology of which is poorly understood. The purpose of this study is to characterize the bronchiectasis seen in patients with hematologic malignancy.

METHODS: Patients were prospectively evaluated between August 2009 and March 2011. HRCTs confirmed the presence of bronchiectasis and were graded by an independent radiologist. Demographic and clinical features, pulmonary function tests, sputum culture results and immunoglobulin levels were analyzed and compared to bronchiectasis patients without malignancy.

RESULTS: Sixteen patients with hematologic malignancy were available for analysis. Patients were 62.5% male. Mean age was 55.75 (16.0) years. Types and number of malignancies: acute lymphocytic leukemia, 4 cases; chronic lymphocytic leukemia, 5 cases; acute monocytic leukemia, 3 cases; chronic monocytic leukemia, 1 case; non-Hodgkin lymphoma, 2 cases; Waldenström’s macroglobulinema, 1 case. Ten (62.5%) patients were recipients of stem cell transplantation and 7 (43.8%) patients had a history of graft versus host disease (GVHD). Clinical features included cough in 15 (93.8%) patients, sinus congestion in 7 (43.8%) patients, and hemoptysis in 5 (31.3%) patients. Mean (SD) FEV1% predicted was 65.3 (26.6), mean (SD) FVC % predicted was 73.7 (12.1), and mean (SD) DLCO was 68.2 (27.9). Mean immunoglobulin G level was 729.2 mg/dL (normal > 800). Pseudomonas aeruginosa was identified in the sputum of 6 (37.5%) patients and nontuberculous mycobacteria was present in 3 (18.8%) of patients. Four (25%) patients with bronchiectasis secondary to hematologic malignancy died from respiratory complications. When compared to 16 bronchiectasis patients without malignancy, age, HRCT scores, lung function and sputum culture results were not different (P = NS).

CONCLUSIONS: Bronchiectasis associated with hematologic malignancy occurs even in patients without stem cell transplantation therefore GVHD is not the sole cause of bronchiectasis in this population. It is associated with significant morbidity and reduced lung function. Sputum culture reveals significant pathogens. Bronchiectasis may contribute to mortality in this patient population.

CLINICAL IMPLICATIONS: Bronchiectasis accompanying hematologic malignancy is associated with significant morbidity and mortality.

DISCLOSURE: The following authors have nothing to disclose: Pamela McShane, Neel Patel, Heber MacMahon, Mary Strek, Edward Naureckas

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