Bronchoalveolar Lavage and Response to Cyclophosphamide in Scleroderma Interstitial Lung Disease
Authors: Charlie Strange, Marcy B. Bolster, Michael D. Roth, Richard M. Silver, Arthur Theodore, Jonathan Goldin, Philip Clements, Joanie Chung, Robert M. Elashoff, Robert Suh, Edwin A. Smith, Daniel E. Furst, Donald P. Tashkin, Philip J. Clements, Robert Elashoff, Michael Roth, Daniel Furst, Ken Bulpitt, Dinesh Khanna, Wen Ling Joanie Chung, Sherrie Viasco, Mildred Sterz, Lovlette Woolcock, Xiaohong Yan, Judy Ho, Sarinnapha Vasunilashorn, Irene Da Costa, James R. Seibold, David J. Riley, Judith K. Amorosa, Vivien M. Hsu, Deborah A. McCloskey, Julianne E. Wilson, John Varga, Dean Schraufnagel, Andrew Wilbur, David Lapota, Shiva Arami, Patricia Cole-Saffold, Robert Simms, Peter Clarke, Joseph Korn, Kimberley Tobin, Melynn Nuite, Richard Silver, Marcie Bolster, Steve Schabel, Edwin Smith, June Arnold, Katie Caldwell, Michael Bonner, Robert Wise, Fred Wigley, Barbara White, Laura Hummers, Mark Bohlman, Albert Polito, Gwen Leatherman, Edrick Forbes, Marie Daniel, Virginia Steen, Charles Read, Cirrelda Cooper, Sean Wheaton, Anise Carey, Adriana Ortiz, Maureen Mayes, Ed Parsley, Sandra Oldham, Tan Filemon, Samantha Jordan, Marilyn Perry, Kari Connolly, Jeffrey Golden, Paul Wolters, Richard Webb, John Davis, Christine Antolos, Carla Maynetto, Naomi Rothfield, Mark Metersky, Richard Cobb, Macha Aberles, Fran Ingenito, Elena Breen, Kamal Mubarak, Jose L. Granda, Joseph Silva, Zora Injic, Ronika Alexander, Steven Springmeyer, Steven Kirkland, Jerry A Molitor, Richard Hinke, Amanda Mondt, Mitchell Olman, Barri Fessler, Colleen Sanders, Louis Heck, Tina Parkhill
Journal: American Journal of Respiratory and Critical Care Medicine (2007)

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).