Abstract
Background: Acute pulmonary hemorrhage is an established complication during remission induction in patients with AML. Its pathogenesis is not well known. Injury to the alveolar capillary endothelium and release of inflammatory cytokines may play a role. The standard management is usually not effective.
Aim: To analyze the course of patients with newly diagnosed AML who develop pulmonary hemorrhage during induction chemotherapy.
Study Group: 1765 patient with AML received frontline therapy from 1998–2005. We analyzed 53 patients (3%) who were admitted to medical intensive care unit due to acute pulmonary hemorrhage.
Results: The incidence of pulmonary hemorrhage was 3%. Outcome by patients characteristic was:
| parameters . | category . | Total No. . | Pulmonary Hemorrhage . | (%) . | P value . |
|---|---|---|---|---|---|
| Age (years) | >60 ≤60 | 998 767 | 32 21 | 3% 3% | 0.569 |
| Diagnosis | M3 M4-M5 others | 109 319 1337 | 812 33 | 7% 4% 2% | 0.011 |
| Platelet (×109/L) | ≥20 <20 | 1475 290 | 43 10 | 3% 3% | 0.624 |
| WBC (×109/L) | >10 ≤10 | 653 1112 | 32 21 | 5% 2% | 0.000 |
| Performance status | 0–2 3–4 | 1662 103 | 44 9 | 3% 9% | 0.000 |
| Serum CR (mg/dl) | <1.5 >1.5 | 1622 140 | 46 7 | 3% 5% | 0.150 |
| HGB (g/dl) | <8.0 >8.0 | 872 893 | 32 21 | 4% 2% | 0.105 |
| Infection | No Yes | 1218 494 | 32 21 | 3% 3% | 0.089 |
| parameters . | category . | Total No. . | Pulmonary Hemorrhage . | (%) . | P value . |
|---|---|---|---|---|---|
| Age (years) | >60 ≤60 | 998 767 | 32 21 | 3% 3% | 0.569 |
| Diagnosis | M3 M4-M5 others | 109 319 1337 | 812 33 | 7% 4% 2% | 0.011 |
| Platelet (×109/L) | ≥20 <20 | 1475 290 | 43 10 | 3% 3% | 0.624 |
| WBC (×109/L) | >10 ≤10 | 653 1112 | 32 21 | 5% 2% | 0.000 |
| Performance status | 0–2 3–4 | 1662 103 | 44 9 | 3% 9% | 0.000 |
| Serum CR (mg/dl) | <1.5 >1.5 | 1622 140 | 46 7 | 3% 5% | 0.150 |
| HGB (g/dl) | <8.0 >8.0 | 872 893 | 32 21 | 4% 2% | 0.105 |
| Infection | No Yes | 1218 494 | 32 21 | 3% 3% | 0.089 |
The predictive factors for pulmonary hemorrhage were: leukemia morphology (M3, M4–5), performance status and WBC count. The 8week survival of patients who develop pulmonary hemorrhage was 32%, (median survival days from pulmonary hemorrhage to death is 16 days).
Conclusion: pulmonary hemorrhage is a serious complication of induction therapy in AML. Modalities that reduce its incidence are needed.
Disclosures: No relevant conflicts of interest to declare.
Author notes
Corresponding author
