Fluid overload is associated with increased 90-day mortality in AML patients undergoing induction chemotherapy

Olivier Ballo,Franziska Frank,Björn Steffen,Hubert Serve,Stefan Büttner,Fabian Finkelmeier,Sebastian Koschade,Christian H Brandts,Jan Alexander Stratmann,Sebastian Wagner,Fagr Eladly,Uta Brunnberg,Eva-Maria Kreisel

doi:10.1007/s00277-021-04593-x

Abstract

Treatment‐related complications contribute substantially to morbidity and mortality in acute myeloid leukemia (AML) patients undergoing induction chemotherapy. Although AML patients are susceptible to fluid overload (FO) (e.g., in the context of chemotherapy protocols, during sepsis treatment or to prevent tumor lysis syndrome), little attention has been paid to its role in AML patients undergoing induction chemotherapy. AML patients receiving induction chemotherapy between 2014 and 2019 were included in this study. FO was defined as ≥5% weight gain on day 7 of induction chemotherapy compared to baseline weight determined on the day of admission. We found FO in 23 (12%) of 187 AML patients undergoing induction chemotherapy. Application of >100 ml crystalloid fluids/kg body weight until day 7 of induction chemotherapy was identified as an independent risk factor for FO. AML patients with FO suffered from a significantly increased 90-day mortality rate and FO was demonstrated as an independent risk factor for 90-day mortality. Our data suggests an individualized, weight-adjusted calculation of crystalloid fluids in order to prevent FO-related morbidity and mortality in AML patients during induction chemotherapy. Prospective trials are required to determine the adequate fluid management in this patient population.

Highlights

Acute myeloid leukemia (AML) is a hematological malignancy arising from a clonal proliferation of myeloid precursors losing their ability to differentiate into matureIn critically ill patients, fluid overload (FO) is associated with a higher risk of kidney failure, increased mortality, and the risk of irreversible organ damage, especially pulmonary dysfunction due to capillary leakage [7,8,9]
AML patients are prone to positive fluid balance due to excessive fluid input, very little attention has been paid to its role in AML patients undergoing induction chemotherapy
AML patients are prone to positive fluid balance, e.g., with the intention to prevent hyperuricemia-induced renal injury, tumor lysis syndrome (TLS), and leukostasis, to our knowledge, there is no study investigating the role of FO in AML patients undergoing induction chemotherapy

Summary

Introduction

Fluid overload (FO) is associated with a higher risk of kidney failure, increased mortality, and the risk of irreversible organ damage, especially pulmonary dysfunction due to capillary leakage [7,8,9]. AML patients are prone to positive fluid balance due to excessive fluid input (e.g., in the context of chemotherapy protocols, during sepsis treatment or due to blood transfusions), very little attention has been paid to its role in AML patients undergoing induction chemotherapy. Chamoun et al have shown that 63 (34%) of 187 patients with acute promyelocytic leukemia (APL) develop FO during induction treatment. Increased LDH and creatinine levels, low albumin, and the total volume of blood product transfusions were identified as risk factors for the development of FO during induction therapy [12]. In the context of allogenic SCT, FO was correlated with a higher non-relapse mortality and impaired overall survival (OS) [14, 15]

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