Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

Rabbat, Antoine; Chaoui, Driss; Lefebvre, A.; Roche, N.; Legrand, Ollivier; Lorut, Christine; B, Rio; Jp, Marie; Huchon, G.

doi:10.1038/leu.2008.100

Cited by 45 publications

(28 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[19][20][21][22] In the context of hematologic patients who are admitted to the intensive care unit for various respiratory complications, the overall diagnostic yield of bronchoscopy was previously shown to be associated with the underlying disease and with neutropenia. 23 These results raise the question of whether the mycologic diagnostic yield of bronchoscopy would differ according to the underlying hematologic condition in the specific context of IPA. This hypothesis is supported by the fact that hematologic patients constitute a heterogeneous population of patients who differ with respect to the specific defects in host defense mechanisms leading to the risk of developing IPA.…”

Section: Introductionmentioning

confidence: 87%

The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies

Bergeron

Porcher

Sulahian

et al. 2012

Blood

124

View full text Add to dashboard Cite

The identification of the causative organism in invasive pulmonary aspergillosis (IPA) is recommended. We investigated whether a mycologic diagnostic strategy could be optimized based on patient characteristics. Fifty-five patients were enrolled in a prospective study. The presence of Aspergillus in respiratory samples occurred more frequently in non-acute leukemia (AL) patients than in AL patients (P ‫؍‬ .0003), and in patients with leukocyte counts more than 100/mm 3 (P ‫؍‬ .002). In a logistic regression model, these 2 factors appeared to be independent, with an adjusted odds ratio of 7.14 (95% confidence interval, 1.40-36.5) for non-AL patients and an adjusted odds ratio of 6.97 (95% confidence interval, 1.33-36.5) for patients with leukocyte counts more than 100/mm 3 . A positive mycologic result was also more frequent among patients with lung CT scan signs of airway-invasive disease than among other patients (P ‫؍‬ .043). Airway-invasive signs were more frequent among non-AL patients (P ‫؍‬ .049), whereas angioinvasive disease was more frequent among both AL patients (P ‫؍‬ .01) and patients with leukocyte counts less than 100/mm 3 (P ‫؍‬ .001). A concomitant pulmonary infection was identified more frequently among non-AL patients (P ‫؍‬ .005 vs allogeneic hematopoietic stem cell transplant and P ‫؍‬ .048 vs others). Our results suggest that different strategies for diagnosing IPA should be considered based on the underlying condition. (Blood. 2012;119(8):1831-1837) Continuing Medical Education onlineThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see

show abstract

Section: Introductionmentioning

confidence: 87%

The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies

Bergeron

Porcher

Sulahian

et al. 2012

Blood

124

View full text Add to dashboard Cite

show abstract

“…Indeed, more than half of our patients were admitted to the ICU due to infectious complications, such as septicemia, and respiratory failure known to be mostly of infectious origin. 28,[29][30][31] Interestingly, other disease-and patient-related factors including age, FAB subtype, and the karyotype, all known to be correlated with long-term survival, were not associated with ICU admission. Our findings underline the importance of tight adherence to guidelines concerning the prevention and treatment of infectious complications in patients with hematologic malignancies.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience

Schellongowski¹,

Staudinger²,

Kundi³

et al. 2010

Haematologica

115

View full text Add to dashboard Cite

BackgroundAcute myeloid leukemia is a life-threatening disease associated with high mortality rates. A substantial number of patients require intensive care. This investigation analyzes risk factors predicting admission to the intensive care unit in patients with acute myeloid leukemia eligible for induction chemotherapy, the outcome of these patients, and prognostic factors predicting their survival. Design and MethodsA total of 406 consecutive patients with de novo acute myeloid leukemia (15-89 years) were analyzed retrospectively. Markers recorded at the time of diagnosis included karyotype, fibrinogen, C-reactive protein, and Charlson comorbidity index. In patients requiring critical care, the value of the Simplified Acute Physiology Score II, the need for mechanical ventilation, and vasopressor support were recorded at the time of intensive care unit admission. The independent prognostic relevance of the parameters was tested by multivariate analysis. ResultsSixty-two patients (15.3%) required intensive care, primarily due to respiratory failure (50.0%) or life-threatening bleeding (22.6%). Independent risk factors predicting intensive care unit admission were lower fibrinogen concentration, the presence of an infection, and comorbidity. The survival rate was 45%, with the Simplified Acute Physiology Score II being the only independent prognostic parameter (P<0.05). Survival was inferior in intensive care patients compared to patients not admitted to an intensive care unit. However, no difference between intensive care and non-intensive care patients was found concerning continuous complete remission at 6 years or survival at 6 years in patients who survived the first 30 days after diagnosis (nonintensive care patients: 28%; intensive care patients: 20%, P>0.05). ConclusionsOngoing infections, low fibrinogen and comorbidity are predictive for intensive care unit admission in acute myeloid leukemia. Although admission was a risk factor for survival, continuous complete remission and survival of patients alive at day 30 were similar in patients who were admitted or not admitted to an intensive care unit.Key words: acute myeloid leukemia, intensive care unit, outcome, infection.Citation: Schellongowski P, Staudinger T, Kundi M, Laczika K, Locker GJ, Bojic A, Robak O, Fuhrmann V, Jäger U, Valent P, and Sperr WR. Prognostic IntroductionAcute myeloid leukemia (AML) is a life-threatening stem cell disorder characterized by rapid and uncontrolled proliferation and accumulation of myeloblasts.1,2 The prognosis and clinical course of AML differs among patients depending on specific molecular and cytogenetic properties of the clone.1-9 Moreover, apart from diseaseassociated features, patient-related factors including age and pre-or co-existing diseases (comorbidity) are of prognostic importance. 1,[10][11][12] Although the rate of complete remission in AML patients is relatively high (ranging between 60 and 75%), only a small percentage of patients are permanently cured. [12][13][14] Patients with AML usually pres...

show abstract

“…It is important to note, as mentioned, that there may be a higher risk of life-threatening complications with FB in patients treated for HM or undergoing HCT in the ICU with severe respiratory complications: in one study, 12 of 121 (10%) of patients had a lifethreatening complication from FB. 79 The high complication rate For personal use only. on May 11, 2018.…”

Section: Fbmentioning

confidence: 99%

How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation

Wingard

Hiemenz

Jantz

2012

Blood

View full text Add to dashboard Cite

Pulmonary nodules and nodular infiltrates occur frequently during treatment of hematologic malignancies and after hematopoietic cell transplantation. In patients not receiving active immunosuppressive therapy, the most likely culprits are primary lung cancer, chronic infectious or inactive granulomata, or even the underlying hematologic disease itself (especially in patients with lymphoma). In patients receiving active therapy or who are otherwise highly immunosuppressed, there is a wider spectrum of etiologies with infection being most likely, especially by bacteria and fungi. Characterization of the pulmonary lesion by highresolution CT imaging is a crucial first diagnostic step. Other noninvasive tests can often be useful, but invasive testing by bronchoscopic evaluation or acquisition of tissue by one of several biopsy techniques should be performed for those at risk for malignancy or invasive infection unless contraindicated. The choice of the optimal biopsy technique should be individualized, guided by location of the lesion, suspected etiology, skill and experience of the diagnostic team, procedural risk of complications, and patient status. Although presumptive therapy targeting the most likely etiology is justified in patients suspected of serious infection while evaluation proceeds, a structured evaluation to determine the specific etiology is recommended. Interdisciplinary teamwork is highly desirable to optimize diagnosis and therapy. (Blood. 2012;120(9):1791-1800)

show abstract

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

Cited by 45 publications

References 29 publications

The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies

The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies

Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience

How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation

Contact Info

Product

Resources

About