Respiratory failure due to pulmonary leukostasis following chemotherapy of acute nonlymphocytic leukemia

Abstract

Four patients with acute nonlymphocytic leukemia and leukocyte counts of more than 200,000/mm3 developed respiratory distress due to pulmonary leukostasis within 10–48 hours after initiation of chemotherapy. Clinically, the patients manifested fever, dyspnea, tachypnea, diffuse pulmonary rales, pleural effusions, and severe hypoxemia. Chest roentgenograms displayed diffuse pulmonary infiltrates, vascular engorgement, cardiomegaly, and pleural effusions. Three patients died from progressive respiratory failure despite ventilatory support. Pulmonary histology revealed thrombi composed of leukemic blast cells which obstructed and distended the lumens of pulmonary arterioles, capillaries, and venules. Electron microscopy studies of lung tissue showed pulmonary alveolar endothelium and basement membrane damage and interstitial edema. The pathophysiologic basis of pulmonary leukostasis and potential treatment modalities are discussed.

FLT-3 ITD Positive Acute Basophilic Leukemia with Rare Complex Karyotype Presenting with Acute Respiratory Failure: Case Report

“…In this case, CD56 expression on basophilic blasts might have specifically facilitated the development of leukostasis. Spontaneous or post therapeutic worsening of respiratory failure in patients with pulmonary leukostasis has been previously cited in hypercellular myelomonocytic leukemias [23,24].…”

Chemotherapy exposure increases leukemia cell stiffness

“…This observed link between cell death and increasing cell stiffness may have implications for patients with acute leukemia and hyperleukocytosis. In some cases, clinical deterioration due to leukostasis paradoxically does not occur until after chemotherapy has been initiated, [18][19][20][21] and alteration of leukemic cells' biophysical properties by chemotherapeutic agents has been hypothesized as a possible link. 19,20,22 Further research is needed to fully characterize the impact of decreased deformability of dying cells as well as the role of other factors like leukemia cell-endothelial interactions and transmigration on the pathophysiology of leukostasis in acute leukemia.…”

Distinguishing the Causes of Pulmonary Infiltrates in Patients With Acute Leukemia

“…15 However, patients with hyperleukocytosis might develop respiratory failure due to pulmonary leukostasis, and present with fever, dyspnea, hypoxemia, diffuse lung infiltrates, pleural effusions, and a rapidly fatal clinical course. 17 A study evaluated risk factors for early mortality during induction therapy in 85 patients with acute myeloid leukemia (AML) who presented with hyperleukocytosis. Pulmonary leukostasis was associated with failure to achieve complete remission and an increased risk of early mortality.…”