Acute Pulmonary Hemorrhage in Patients with Acute Myeloid Leukemia (AML) during Remission Induction Chemotherapy

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:parameterscategoryTotal No.Pulmonary Hemorrhage(%)P valueAge (years)>60 ≤60998 76732 213% 3%0.569DiagnosisM3 M4-M5 others109 319 1337812 337% 4% 2%0.011Platelet (×109/L)≥20 <201475 29043 103% 3%0.624WBC (×109/L)>10 ≤10653 111232 215% 2%0.000Performance status0–2 3–41662 10344 93% 9%0.000Serum CR (mg/dl)<1.5 >1.51622 14046 73% 5%0.150HGB (g/dl)<8.0 >8.0872 89332 214% 2%0.105InfectionNo Yes1218 49432 213% 3%0.089The 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.