title: Pneumonia during remission induction chemotherapy in patients with acute leukemia.
abstract: BACKGROUND
  Pneumonia is a major cause of death during induction chemotherapy for acute leukemia. The purpose of this study was to quantify the incidence, risk factors, and outcomes of pneumonia in patients with acute leukemia.
  
  
  METHODS
  We conducted a retrospective cohort study of 801 patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or acute lymphocytic leukemia (ALL) who underwent induction chemotherapy.
  
  
  RESULTS
  Pneumonia was present at induction start in 85 patients (11%). Of the 716 remaining patients, 148 (21%) developed pneumonia. The incidence rate of pneumonia was higher in MDS and AML than in ALL (0.013 vs. 0.008 vs. 0.003 pneumonias per day, respectively; P < 0.001). In multivariate analysis, age greater than or equal to 60 years, AML, low platelet count, low albumin level, neutropenia, and neutrophil count greater than 7,300 were risk factors. The case fatality rate of pneumonia was 17% (40 of 233). Competing risk analysis demonstrated that in the absence of pneumonia, death was rare: 28-day mortality was 6.2% for all patients but only 1.26% in those without pneumonia. Compared with patients without pneumonia, patients with pneumonia had more intensive care unit days, longer hospital stays, and 49% higher costs (P < 0.001).
  
  
  CONCLUSIONS
  Pneumonia after induction chemotherapy for acute leukemia continues to be common, and it is the most important determinant of early mortality after induction chemotherapy. Given the high incidence, morbidity, mortality, and cost of pneumonia, interventions aimed at prevention are warranted in patients with acute leukemia.
authors.affiliation: 1 Department of Pulmonary Medicine.
authors.forename: Javier Barreda
authors.initials: JB
authors.lastname: Garcia
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.forename: William
authors.initials: W
authors.lastname: Wierda
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Cortes
authors.forename: Burton F
authors.initials: BF
authors.lastname: Dickey
authors.forename: Scott E
authors.initials: SE
authors.lastname: Evans
authors.forename: David E
authors.initials: DE
authors.lastname: Ost
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia; D060828:Induction Chemotherapy; D007938:Leukemia / Q000150:complications* / Q000188:drug therapy; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia; D009894:Opportunistic Infections / Q000150:complications* / Q000401:mortality; D011014:Pneumonia / Q000150:complications* / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia