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.
Al Ameri
Ali
A
Leukemia Department, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Koller
Charles
C
Kantarjian
Hagop
H
Ravandi
Farhad
F
Verstovsek
Srdan
S
Borthakur
Gautam
G
Pierce
Sherry
S
Mattiuzzi
Gloria
G
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