Fluid overload is associated with increased 90-day mortality in AML patients undergoing induction chemotherapy

Abstract

Treatment‐related complications contribute substantially to morbidity and mortality in acute myeloid leukemia (AML) patients undergoing induction chemotherapy. Although AML patients are susceptible to fluid overload (FO) (e.g., in the context of chemotherapy protocols, during sepsis treatment or to prevent tumor lysis syndrome), little attention has been paid to its role in AML patients undergoing induction chemotherapy. AML patients receiving induction chemotherapy between 2014 and 2019 were included in this study. FO was defined as ≥5% weight gain on day 7 of induction chemotherapy compared to baseline weight determined on the day of admission. We found FO in 23 (12%) of 187 AML patients undergoing induction chemotherapy. Application of >100 ml crystalloid fluids/kg body weight until day 7 of induction chemotherapy was identified as an independent risk factor for FO. AML patients with FO suffered from a significantly increased 90-day mortality rate and FO was demonstrated as an independent risk factor for 90-day mortality. Our data suggests an individualized, weight-adjusted calculation of crystalloid fluids in order to prevent FO-related morbidity and mortality in AML patients during induction chemotherapy. Prospective trials are required to determine the adequate fluid management in this patient population.

Cardiovascular Management of Patients Undergoing Hematopoietic Stem Cell Transplantation: From Pretransplantation to Survivorship: A Scientific Statement From the American Heart Association

“…Iatrogenic volume overload is common in patients with cancer. [104][105][106][107][108] Because large volumes of fluids are administered during HSCT, patients at risk for heart failure should undergo daily weight monitoring, with diuretics administered for 2-to 3-lb fluctuations within 24 hours to avert hypervolemia. 105…”

“…Iatrogenic volume overload is common in patients with cancer. 104–108 Because large volumes of fluids are administered during HSCT, patients at risk for heart failure should undergo daily weight monitoring, with diuretics administered for 2- to 3-lb fluctuations within 24 hours to avert hypervolemia. 105 Moreover, volume shifts and systemic inflammation related to engraftment or infections can trigger supraventricular arrhythmias, most commonly atrial fibrillation.…”