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Published ahead of print on September 27, 2007, doi:10.1164/rccm.200705-655OC

Am. J. Respir. Crit. Care Med., Volume 177, Number 1, January 2008, 91-98

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Submitted on May 2, 2007
Accepted on September 27, 2007

Bronchoalveolar Lavage and Response to Cyclophosphamide in Scleroderma Interstitial Lung Disease

Charlie Strange1*, Marcy B Bolster2, Michael D Roth3, Richard M Silver2, Arthur Theodore4, Jonathan Goldin5, Philip Clements6, Joanie Chung7, Robert M Elashoff7, Robert Suh5, Edwin A Smith2, Daniel E Furst6, Donald P Tashkin3, and the Scleroderma Lung Study Research Group

1 Department of Medicine, Medical University of South Carolina, Division of Pulmonary and Critical Care Medicine, Charleston, SC, USA, 2 Department of Medicine, Medical University of South Carolina, Division of Rheumatology and Immunology, Charleston, SC, USA, 3 Department of Medicine, David Geffen School of Medicine at UCLA, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA, 4 Department of Medicine, Boston University School of Medicine, Division of Pulmnonary, Allergy and Critical Care Medicine, Boston, MA, USA, 5 Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, 6 Department of Medicine, David Geffen School of Medicine at UCLA, Division of Rheumatology and Arthritis, Los Angeles, CA, USA, 7 Department of Biostatistics and Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

* To whom correspondence should be addressed. 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 computerized 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% polymorphonuclear and/or ≥ 2 % 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 % of men (p= 0.04), more severe lung function including a worse forced vital capacity (p=0.003), 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 one year (p=NS).
Key words: systemic sclerosis, chest computed tomography, Scleroderma Lung Study, BAL, SSc




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