Assessing the role of bronchoscopy in the management of patients with acute leukemia—a transversal study and proposal of evaluation

Introduction: Bronchoscopy is frequently performed in the management of patients with acute leukemia due to their high susceptibility to infections. In this setting, it is performed in the context of lung infiltrates on imaging and persistent fever in immunocompromised subjects. This study aimed to evaluate the utility of bronchoscopy in patients with acute leukemia, its diagnostic yield, and its impact on management decisions. Methods: This is a single-center cross-sectional study that included patients diagnosed with acute leukemia of any phenotype who received intensive chemotherapy. Consecutive patients who underwent bronchoscopy as part of a work-up for associated infections were selected, while patients who had undergone bone marrow transplant were excluded. This study investigated patient characteristics and the impact of bronchoscopy on changes in clinical management. Results: Seventy-nine patients who underwent bronchoscopy at various stages of treatment were analyzed. The most frequent type of acute leukemia was acute myeloid leukemia, accounting for 68.3 % of cases. The induction phase was the most prevalent (29.1 %) treatment stage. Bacterial cultures were positive in 17 out of the 74 patients evaluated, with Pseudomonas aeruginosa being the most frequently identified microorganism. A change in medical management was observed in 18.2 % of cases, and only six patients experienced secondary complications. Conclusions: This is the first Brazilian study to evaluate the utility of bronchoscopy in managing infectious complications in patients with acute leukemia. The impact of bronchoscopy on clinical management was less than anticipated, largely due to its low yield in identifying causative agents. Nevertheless, it remains a safe procedure and can be useful in specific situations.