Published ahead of print on September 27, 2007, doi:10.1164/rccm.200705-655OC
© 2008 American Thoracic Society doi: 10.1164/rccm.200705-655OC
Bronchoalveolar Lavage and Response to Cyclophosphamide in Scleroderma Interstitial Lung Disease1 Division of Pulmonary and Critical Care Medicine and 2 Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; 4 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and 5 Department of Radiology, 6 Division of Rheumatology and Arthritis, Department of Medicine, and 7 Department of Biostatistics and Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, California Correspondence and requests for reprints should be addressed to Charlie Strange, M.D., Division of Pulmonary and Critical Care Medicine, MUSC, 96 Jonathan Lucas Street, 812 CSB, Charleston, SC 29425. E-mail: strangec{at}musc.edu Rationale: The presence of inflammatory cells on bronchoalveolar lavage is often used to predict disease activity and the need for therapy in systemic sclerosis–associated interstitial lung disease. Objectives: To evaluate whether lavage cellularity identifies distinct subsets of disease and/or predicts cyclophosphamide responsiveness. Methods: Patients underwent baseline lavage and/or high-resolution computed tomography as part of a randomized placebo-controlled trial of cyclophosphamide versus placebo (Scleroderma Lung Study) to determine the effect of therapy on forced vital capacity. Patients with 3% or greater polymorphonuclear and/or 2% or greater eosinophilic leukocytes on lavage and/or ground-glass opacification on computed tomography were eligible for enrollment. Measurements and Main Results: Lavage was performed in 201 individuals, including 141 of the 158 randomized patients. Abnormal cellularity was present in 101 of these cases (71.6%) and defined a population with a higher percentage of men (P = 0.04), more severe lung function, including a worse forced vital capacity (P = 0.003), worse total lung capacity (P = 0.005) and diffusing capacity of the lung for carbon monoxide (P = 0.004), more extensive ground-glass opacity (P = 0.005), and more extensive fibrosis in the right middle lobe (P = 0.005). Despite these relationships, the presence or absence of an abnormal cell differential was not an independent predictor of disease progression or response to cyclophosphamide at 1 year (P = not significant). Conclusions: The presence of an abnormal lavage in the Scleroderma Lung Study defined patients with more advanced interstitial lung disease but added no additional value to physiologic and computed tomography findings as a predictor of progression or treatment response. Clinical trial registered with www.clinicaltrials.gov (NCT 000004563).
Key Words: systemic sclerosis • Scleroderma Lung Study
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