Pulmonary infections and acute respiratory failure remain a significant cause of morbidity and mortality in newly diagnosed acute leukemia (AL) patients. Bronchoscopy with bronchoalveolar lavage (BAL) is commonly employed to evaluate potential infections in this setting but there is limited data regarding its utility. We retrospectively reviewed BAL study data in 70 newly diagnosed AL patients who had bronchoscopy performed at our institution over a 6.5 year period to assess frequency with which a previously unknown pathogen was identified and subsequent changes in antimicrobial therapy guided by BAL results. BAL identified clinically significant organisms in 17 (24.3%) patients, including 7 bacterial, 11 viral, and 3 fungal pathogens. However, novel infections not previously demonstrated on microbiological studies obtained prior to bronchoscopy were found in only 10 (14.3%) patients. Additional antimicrobial therapy was initiated solely on the basis of BAL data in just 5 (7.14%) patients. Collectively, BAL data did not change treatment of infection in 92.7% of the study population. BAL results were not significantly associated with any demographic or clinical variables investigated and did not predict 30 day survival. In conclusion, in newly diagnosed AL patients, bronchoscopy has relatively low clinical utility due to infrequent identification of new pathogens and therefore little impact on antimicrobial selection. Bronchoscopy may be avoided in this population without compromising patient outcomes. This article is protected by copyright. All rights reserved.