Acute pulmonary failure during remission induction chemotherapy in adults with acute myeloid leukemia or high‐risk myelodysplastic syndrome

Abstract

BACKGROUND: Acute pulmonary failure during remission induction therapy is a serious complication in patients with acute myeloid leukemia (AML). To the authors' knowledge, the course and prognosis of such patients is not well known. METHODS: A total of 1541 patients referred for remission induction chemotherapy of AML or high-risk myelodysplastic syndrome were retrospectively reviewed. RESULTS: A total of 120 (8%) patients developed acute pulmonary failure within 2 weeks of the initiation of chemotherapy; 87 of these patients (73%) died during remission induction, whereas 17 (14%) achieved a complete response. The median survival among the 120 patients with early acute pulmonary failure was 3 weeks. Predictive factors for the development of early acute pulmonary failure by multivariate analysis were: male sex (P ¼ .00038), acute promyelocytic leukemia (P ¼ .00003), poor performance status (P ¼ .001), lung infiltrates at diagnosis (P ¼ .000001), and increased creatinine (P ¼ .000005). Patients who had 0 to 1, 2, 3, or 4 to 5 adverse factors were found to have estimated predictive incidences of acute pulmonary failure of 3%, 13%, 23%, and 34%, respectively. CONCLUSIONS: Preventive approaches at the start of induction therapy in patients at high risk of pulmonary failure may improve the outcome of these patients. Cancer 2010;116: 93-7.

How I treat acute myeloid leukemia presenting with preexisting comorbidities

“…In a large retrospective study, following intensive induction therapy, grade 3-4 respiratory complications requiring support were present in 16% of AML patients and 8% developed respiratory failure. 76,77 In addition, pulmonary hypertension raises the mortality from sepsis. 78 At the age 62 years, with COPD, patients with AML that evolved from myelodysplastic syndrome need to overcome significant obstacles inherent in intensive chemotherapy.…”

How to manage lung infiltrates in adults suffering from haematological malignancies outside allogeneic haematopoietic stem cell transplantation

“…A favourable clinical response to antibacterial treatment is achieved in less than 1 in 3 patients with pulmonary infiltrates during febrile neutropenia (Maschmeyer et al , ; Raad et al , ) with a high fatality rate (Al Ameri et al , ), while the addition upfront of mould‐active systemic antifungals, such as amphotericin B or voriconazole, increases the response rate to up to 78% (Schiel et al , ). Additional findings indicate that the majority of LI among severely neutropenic patients are caused by filamentous fungi, particularly Aspergillus spp., including a reduction in the incidence of LI in a small study of voriconazole prophylaxis in patients with acute leukaemia (Vehreschild et al , ), histopathological and molecular findings (Lass‐Flörl et al , ) and autopsy studies (Chamilos et al , ).…”

Pulmonary Infiltrates in Acute Myeloid Leukemia During Induction Treatment

“…In this study, 1541 patients received induction chemotherapy, and of these, 120 (8%) developed acute pulmonary failure and required ventilatory support within 2 weeks of the initiation of chemotherapy, and the mortality rate during induction therapy for this group of patients was 73%. 12 The causes of pulmonary infiltrates in AML during induction therapy are broad and may be overlapping; they include infectious and noninfectious processes, and clinically it is difficult to identify a definite etiology. However, aggressive supportive care is essential in patients with pulmonary infiltrates that develop during AML induction therapy.…”