Respiratory events at the earliest phase of acute myeloid leukemia.
Acute myeloid leukemia (AML) can result in acute respiratory failure (ARF) during the first days, requiring intensive care unit (ICU) admission in half the cases. We describe three leukemia-specific syndromes responsible for ARF: leukostasis, pulmonary leukemic infiltration (PLI) and acute lysis pneumopathy (ALP). We retrospectively analyzed clinical and laboratory data from 114 patients admitted to a medical ICU within 10 days after a diagnosis of AML. Respiratory events (REs) occurred in 95 patients and were leukemia-specific in 58 patients (61%). Day-28 mortality was 34.5% in patients with leukemia-specific REs (leukostasis, 41%; PLI, 23%; and ALP, 31%) and 48.6% in patients with other REs. By multivariate analysis, independent risk factors for death were age > 50 (odds ratio, 13; 95% confidence interval, 3-51), Eastern Cooperative Oncology Group (ECOG) status ≥ 2 (5.4; 1.8-17) and need for invasive mechanical ventilation (19; 5-75). Dexamethasone therapy was protective (0.26; 0.09-0.8), suggesting a role as a preventive treatment in patients with AML-related non-infectious pulmonary involvement.
Medical Intensive Care Unit, Saint-Louis University Hospital , Paris , France.
Anne-Sophie
AS
Moreau
Etienne
E
Lengline
Amélie
A
Seguin
Virginie
V
Lemiale
Emmanuel
E
Canet
Emmanuel
E
Raffoux
Benoit
B
Schlemmer
Elie
E
Azoulay
D000208:Acute Disease; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007951:Leukemia, Myeloid / Q000150:complications* / Q000473:pathology; D017254:Leukemic Infiltration / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D018921:Leukostasis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008171:Lung Diseases / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone
Acute lung injury; leukemia; prognosis; steroids