Radiological Characterization of Pulmonary Involvement in Patients With Hematological Diseases

Hematologic malignancies are heterogeneous groups of neoplasia, with frequent pulmonary complications. These complications may be secondary to the patient's comorbidities, to the hemopathy itself, or its treatments. Divided into infectious and non-infectious complications, the etiologies are numerous and varied. This makes the diagnostic approach complex for the clinicians

Study Overview

• Status: Completed
• Conditions: Hematologic Diseases
• Intervention / Treatment: Diagnostic test: Complete Blood Count; Diagnostic test: C-reactive protein; Diagnostic test: O2 saturation; Diagnostic test: Serum ferritin and D-dimer; Diagnostic test: Liver and renal function tests; Diagnostic test: Lactate dehydrogenase; Diagnostic test: coronavirus (SARS-CoV-2) swab; Radiation: CT chest

Detailed Description

Although infectious processes of the lungs are common in these immunosuppressed patient collectives, non-infectious causes account for up to half of the pulmonary manifestations found in hematologic malignancies. Besides the frequent infections including opportunistic pathogens, a broad differential diagnosis including drug-induced lung injury by cytostatic substances, cytokines, and innovative immunotherapeutic agents, rarer transfusion of blood products, and intrathoracic manifestations of the hematologic malignancy itself, must be kept in mind. Finally, vascular complications can also lead to pulmonary reactions. Early and consistent diagnostics and treatment of bronchopulmonary, intrathoracic, and vascular complications within the framework of hematologic systemic diseases can be essential for the patient's prognosis. Up to 25% of patients with profound neutropenia lasting for >10 days develop lung infiltrates, which frequently do not respond to broad-spectrum antibacterial therapy. While a causative pathogen remains undetected in most cases, Aspergillus spp., Pneumocystis jirovecii, multi-resistant Gram-negative pathogens, mycobacteria or respiratory viruses may be involved. In at-risk patients who have received trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis, filamentous fungal pathogens appear to be predominant, yet commonly not proven at the time of treatment initiation.

In patients who do not improve rapidly with first-line therapy with broad spectrum antibiotics, cross-sectional thoracic CT imaging is essential. It provides much better definition of the pattern of radiological changes that includes three main groups: consolidation, nodules (micro- and macro-), and diffuse changes, as ground glass pattern. Discuss these radiological patterns and how this guides the appropriate initial investigations and treatment options will be of a great value to be followed.

• Study Type: Observational
• Enrollment (Actual): 148

Contacts and Locations

Study Locations

• Egypt
  • Asyut, Egypt
    • Assiut University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All patients aged 18 years or older diagnosed with hematological diseases and documented pulmonary manifestations during their disease course will be included in this retrospective study. Data from their medical records will be analyzed by a team of hematologists, pulmonologists, and radiologists.

Description

Inclusion Criteria:

• All patients aged 18 years or older diagnosed with hematological diseases and documented pulmonary manifestations during their disease course

Exclusion Criteria:

1. Patients aged under 18 years.
2. Patients without demonstrable evidence of lung involvement.
3. Patients with incomplete medical records or insufficient data to analyze.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

1; patient admitted with hematological disease and pulmonary manifestations

Diagnostic test: Complete Blood Count; blood sample; Diagnostic test: C-reactive protein; serum sample; Diagnostic test: O2 saturation; blood sample; Diagnostic test: Serum ferritin and D-dimer; Blood sample; Diagnostic test: Liver and renal function tests; Blood sample; Diagnostic test: Lactate dehydrogenase; Blood sample; Diagnostic test: coronavirus (SARS-CoV-2) swab; Throat swab; Radiation: CT chest; Radiation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of patients who had certain radiological patterns associated with pulmonary complications in patients diagnosed with various hematological diseases	Once through the study

Secondary Outcome Measures

Outcome Measure	Time Frame
Number of patients who developed complications	Once through the study

Collaborators and Investigators

• Sponsor: New Valley University

Publications and helpful links

General Publications

• Messe R, Soccal PM, Bergeron A. [Diagnostic approach to pulmonary complications in patients with hematologic malignancy]. Rev Med Suisse. 2021 Nov 17;17(759):1984-1990. French.
• Stecher SS, Lippl S, Stemmler HJ, Schreiber J. [Lung involvement in hematologic systemic diseases]. Internist (Berl). 2018 Sep;59(9):886-897. doi: 10.1007/s00108-018-0471-9. German.
• Maschmeyer G, Carratala J, Buchheidt D, Hamprecht A, Heussel CP, Kahl C, Lorenz J, Neumann S, Rieger C, Ruhnke M, Salwender H, Schmidt-Hieber M, Azoulay E. Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol. 2015 Jan;26(1):21-33. doi: 10.1093/annonc/mdu192. Epub 2014 May 15.
• Periselneris J, Brown JS. A clinical approach to respiratory disease in patients with hematological malignancy, with a focus on respiratory infection. Med Mycol. 2019 Jun 1;57(Supplement_3):S318-S327. doi: 10.1093/mmy/myy138.

Study record dates

Study Major Dates

• Study Start (Actual): September 27, 2024
• Primary Completion (Actual): August 1, 2025
• Study Completion (Actual): November 21, 2025

Study Registration Dates

• First Submitted: February 1, 2024
• First Submitted That Met QC Criteria: April 1, 2024
• First Posted (Actual): April 5, 2024

Study Record Updates

• Last Update Posted (Actual): November 24, 2025
• Last Update Submitted That Met QC Criteria: November 21, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Hemic and Lymphatic Diseases; Hematologic Diseases; Investigative Techniques; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Cell Count; Cytological Techniques; Hematologic Tests; Cell Physiological Phenomena; Blood Physiological Phenomena; Circulatory and Respiratory Physiological Phenomena; Diagnostic Techniques, Urological; Blood Cell Count; Kidney Function Tests
• Other Study ID Numbers: PULMHEMA

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No