title: Pneumonia during remission induction chemotherapy in patients with AML or MDS.
abstract: We analyzed the 67 of 278 patients with newly-diagnosed AML or 'high-risk' MDS, treated in 1994 and 1995, who developed pneumonia during course 1 of their induction therapy. Pneumonia responded to treatment in 66%, but outcome depended on when pneumonia was diagnosed. Patients with pneumonia diagnosed during week 1 or 2 (group 2 patients) had the lowest response rate (43%). Patients who developed pneumonia in the 3rd week after treatment initiation had the best outcome with all 16 patients recovering. Patients presenting with pneumonia had an intermediate response rate (75%). The different patient groups were comparable with regard to age, underlying disease, prophylactic therapy, and G-CSF application. Although a lower CR rate was not entirely responsible for the lower response rate in group 2, failure to achieve CR predicted unsuccessful treatment of pneumonia in all groups. Fungal pathogens appeared more common in group 2 patients. However, in these patients, administration of amphotericin B was associated with a significantly higher failure rate (15/21 failures vs 2/9 who received no amphotericin B). We conclude that patients who develop pneumonia during week 1 or 2 are a high-risk group, and that use of amphotericin B indicates a particularly poor prognosis, although we present data suggesting that earlier use of amphotericin might be beneficial. Furthermore, since achievement of CR was an important prognostic factor in all groups, WBC transfusions particularly from donors given G-CSF should be considered as a therapeutic option. Finally, since time to failure of induction therapy and time to CR were similar in high-risk patients, new chemotherapy regimens could potentially improve both the CR rate and the outcome of pneumonia.
authors.affiliation: Medizinische Poliklinik, University of Würzburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wilhelm
authors.forename: H M
authors.initials: HM
authors.lastname: Kantarjian
authors.forename: S
authors.initials: S
authors.lastname: O'Brien
authors.forename: S
authors.initials: S
authors.lastname: Pierce
authors.forename: M J
authors.initials: MJ
authors.lastname: Keating
authors.forename: E J
authors.initials: EJ
authors.lastname: Freireich
authors.forename: E H
authors.initials: EH
authors.lastname: Estey
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007951:Leukemia, Myeloid / Q000150:complications* / Q000188:drug therapy*; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000188:drug therapy*; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000209:etiology; D012074:Remission Induction; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D000666:Amphotericin B