Premium
Acute pulmonary failure during remission induction chemotherapy in adults with acute myeloid leukemia or high‐risk myelodysplastic syndrome
Author(s) -
Al Ameri Ali,
Koller Charles,
Kantarjian Hagop,
Ravandi Farhad,
Verstovsek Srdan,
Borthakur Gautam,
Pierce Sherry,
Mattiuzzi Gloria
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24711
Subject(s) - medicine , induction chemotherapy , acute promyelocytic leukemia , myeloid leukemia , acute leukemia , chemotherapy , oncology , surgery , leukemia , retinoic acid , biochemistry , chemistry , gene
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 = .1), and increased creatinine ( P = .5). 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. Cancer 2010. © 2010 American Cancer Society.