title: Initial respiratory status in hyperleukocytic acute myeloid leukemia: prognostic significance and effect of leukapheresis.
abstract: This study investigated whether initial respiratory status in hyperleukocytic acute myeloid leukemia (AML), as defined by oxygen/ventilatory support, is (1) associated with early mortality and overall survival and (2) improved after leukapheresis. A retrospective chart review of 89 patients requiring leukapheresis was performed. White blood cell count (WBC) decreased from 153 (56-475) × 10(9)/L to 60 (17-259) × 10(9)/L after first leukapheresis (p < 0.01). Initial respiratory status was room air (n = 40), low (n = 31) or high flow oxygen therapy (n = 8) or mechanical ventilation (n = 10). As compared to admission, respiratory status significantly deteriorated after both first and second leukapheresis (p < 0.01) and was not different at day 5 for patients still alive (p = 0.131). Both day 28 mortality and overall survival were significantly affected by initial respiratory status (p < 0.01). Despite being effective in reducing WBC, leukapheresis did not improve respiratory status of hyperleukocytic AML patients, a factor strongly associated with survival.
authors.affiliation: a Division of Pulmonary and Critical Care Medicine .
authors.forename: Andry
authors.initials: A
authors.lastname: Van de Louw
authors.affiliation: b Department of Internal Medicine , and.
authors.forename: Coursen W
authors.initials: CW
authors.lastname: Schneider
authors.affiliation: b Department of Internal Medicine , and.
authors.forename: Ruchi J
authors.initials: RJ
authors.lastname: Desai
authors.affiliation: c Division of Hematology and Oncology , Penn State Milton S Hershey Medical Center and College of Medicine , Hershey , PA , USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Claxton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007937:Leukapheresis; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D007958:Leukocyte Count; D007964:Leukocytosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D011379:Prognosis; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute myeloid leukemia; acute respiratory failure; leukapheresis; leukostasis