Leukemic cell lysis pneumonopathy a complication of treated myeloblastic leukemia

Abstract

The course of acute noninfectious pulmonary infiltrates in five patients with myeloblastic leukemia was evaluated. All had circulating blast cells (range, 245–192,000/mm3) and recently had received chemotherapeutic drugs for their leukemia. Within four days of the nadir of their leukocyte counts, a patchy, often multilobar pneumonitis developed. Cultures for bacteria, fungi, and viruses were all negative, and no clinical response was observed to broad‐spectrum antibiotics. On lung biopsy, pathologic changes were characterized by diffuse alveolar damage with degenerating blast cells in the interstitium and in organizing alveolar exudates. No potential pathogenic organisms were seen on light or electron microscopy of the biopsy samples. In each case the pulmonary infiltrate resolved without specific therapy. We postulate that lysis of leukemic cells, with subsequent release of their enzyme contents, led to the diffuse alveolar damage observed pathologically. Leukemic cell lysis pneumonopathy may be one of the potential causes of pulmonary infiltrates in leukemic patients and can be distinguished pathologically by its distinctive pattern.

Leukapheresis and cranial irradiation in patients with hyperleukocytic acute myeloid leukemia: No impact on early mortality and intracranial hemorrhage

“…Respiratory failure is perhaps less well recognized [3,18]. While the high blast count itself might lead directly to intravascular leukostasis, it is also thought that damage to the myeloblast cell surface caused by aggressive chemotherapy may also contribute to rapid clumping of cells and ultimately sequestration of the myeloblast in the pulmonary vessels [4], leading to severe or even fatal pulmonary vascular obstruction [19,20], as well as damage to other organs. For this reason, a number of authors have recommended rapid reduction of the high leukocyte count to reduce the potentially lethal consequences of cytotoxic induction chemotherapy [9,[21][22][23][24].…”

A persistent challenge: the diagnosis of respiratory disease in the non-AIDS immunocompromised host

“…However, in the last 20 years some series have shown that pulmonary oedema, specific localisation of the underlying disease such as blastic infiltration or leucostasis,38 39 opportunistic pneumonia resulting from previous immunoglobulin or T cell defect, alveolar proteinosis resulting from macrophage defects (particularly in cases of myeloid disorder40), and alveolar haemorrhage41 42may also be involved. Finally, lung injury due to drugs such as liposomal amphotericin B,43 cytosine arabinoside,44 or all-trans retinoic acid14has also been reported.…”

The Need for Continuing Chemotherapy for Leukemic Cell Lysis Pneumopathy in Patients with Acute Myelomonocytic/Monocytic Leukemia

“…Myers et al described a second type of reaction, termed "leukemic cell lysis pneumonopathy" (5), which causes local tissue damage and hypoxemia as a result of vascular obstruction and oxygen consumption by blast cells, with the injury being perpetuated by toxic and thromboplastic substances released by these cells in response to chemotherapy. Recently, it has been reported that LCLP can occur in patients with leukocyte counts of less than 50,000/μL (4,7,8). A third, similar condition (although the underlying mechanism is different) was reported by Vernant and co-workers (11).…”