Acute pulmonary failure during remission induction chemotherapy in adults with acute myeloid leukemia or high-risk myelodysplastic syndrome.
BACKGROUND
Acute pulmonary failure during remission induction therapy is a serious complication in patients with acute myeloid leukemia (AML). To the authors' knowledge, the course and prognosis of such patients is not well known.


METHODS
A total of 1541 patients referred for remission induction chemotherapy of AML or high-risk myelodysplastic syndrome were retrospectively reviewed.


RESULTS
A total of 120 (8%) patients developed acute pulmonary failure within 2 weeks of the initiation of chemotherapy; 87 of these patients (73%) died during remission induction, whereas 17 (14%) achieved a complete response. The median survival among the 120 patients with early acute pulmonary failure was 3 weeks. Predictive factors for the development of early acute pulmonary failure by multivariate analysis were: male sex (P = .00038), acute promyelocytic leukemia (P = .00003), poor performance status (P = .001), lung infiltrates at diagnosis (P = .000001), and increased creatinine (P = .000005). Patients who had 0 to 1, 2, 3, or 4 to 5 adverse factors were found to have estimated predictive incidences of acute pulmonary failure of 3%, 13%, 23%, and 34%, respectively.


CONCLUSIONS
Preventive approaches at the start of induction therapy in patients at high risk of pulmonary failure may improve the outcome of these patients.
Leukemia Department, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Ali
A
Al Ameri
Charles
C
Koller
Hagop
H
Kantarjian
Farhad
F
Ravandi
Srdan
S
Verstovsek
Gautam
G
Borthakur
Sherry
S
Pierce
Gloria
G
Mattiuzzi
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000188:drug therapy*; D011379:Prognosis; D012074:Remission Induction; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000150:complications* / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors