Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Manuscript
  • Published:

Incidence and prognostic value of respiratory events in acute leukemia

Leukemia volume 18, pages 670–675 (2004)Cite this article

Abstract

Acute respiratory failure and infectious pneumonia are the major causes of death during induction chemotherapy of acute leukemia. However, the causes, incidence and prognostic value of all respiratory events (REs) occurring in this context have never been assessed prospectively. We recruited 65 consecutive patients with newly diagnosed acute leukemia into a 1-year prospective study (December 2000–November 2001) to evaluate the incidence and prognostic value of these events. REs were frequent: 38 were recorded in 30 patients. There was a significant relationship between REs and pre-existing respiratory disease and/or smoking. REs were caused by infection in 34% of cases, by an established cause other than infection in 42% and had an undetermined cause in 24%. Poor early outcome (death within 45 days of starting induction chemotherapy) in patients experiencing an RE was independently associated with a >25/min respiratory rate (P=0.003) and the nonachievement of complete remission (CR) (P<0.0001). Predictors of overall survival in the entire patient population were the absence of CR (P<0.0001), REs (P=0.02) and a ⩾2 performance status (P=0.03). In conclusion, REs are frequent during induction chemotherapy of acute leukemia and represent an independent prognostic factor of poor outcome, regardless of their cause.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Lowenberg B, Dowing JR, Burnett AK . Acute myeloid leukemia. New Engl J Med 1999; 341: 1051–1061.

    Article  CAS  Google Scholar 

  2. Baudard M, Beauchamp-Nicoud A, Delmer A, Rio B, Blanc CM, Zittoun R et al. Has the prognosis of adult patients with acute myeloid leukemia improved over years. A single institution experience of 784 consecutive patients over a 16-years period. Leukemia 1999; 13: 1481–1490.

    Article  CAS  Google Scholar 

  3. Krowka MJ, Rosenow EC, Hoagland HC . Pulmonary complications of bone marrow transplantation. Chest 1985; 87: 237–246.

    Article  CAS  Google Scholar 

  4. Rossini F, Verga M, Pioltelli P, Giltri G, Sancassani V, Pogliani EM et al. Incidence and outcome of pneumonia in patients with acute leukemia receiving first induction therapy with anthracyclines-containing regimens. Haematologica 2000; 85: 1255–1260.

    CAS  PubMed  Google Scholar 

  5. Ewig S, Glasmacher A, Ulrich B, Wilhelm K, Schafer H, Nachtsheim KH . Pulmonary infiltrates in neutropenic patients with acute leukemia during chemotherapy. Chest 1998; 114: 444–451.

    Article  CAS  Google Scholar 

  6. Wilhelm M, Kantarjian HM, O’Brien S, Pierce S, Keating MJ, Freireich EJ et al. Pneumonia during remission induction chemotherapy in patients with AML or MDS. Leukemia 1996; 10: 1870–1873.

    CAS  PubMed  Google Scholar 

  7. Cordonnier C, Escudier E, Verra F, Brochard L, Bernaudin JF, Fleury-Feith J . Bonchoalveolar lavage during neutropenic episodes: diagnostic yield and cellular pattern. Eur Respir J 1994; 7: 114–120.

    Article  CAS  Google Scholar 

  8. Ewig S, Torres A, Riquelme R, El-Elbiary M, Rovira M, Carreras E et al. Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU. Eur Respir J 1998; 12: 116–122.

    Article  CAS  Google Scholar 

  9. Ascioglu S, Rex JH, Pauw B, Bennett JE, Bille J, Crokaert F et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7–14.

    Article  CAS  Google Scholar 

  10. Grimwalde D, Walker H, Oliver F, Wheatley K, Harrison H, Rees J et al. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1612 patients entered into the MRC AML 10 trial. Blood 1998; 92: 2322–2333.

    Google Scholar 

  11. Groupe Français de Cytogénétique Hématologique. Cytogenetic abnormalities in adult acute lymphoblastic leukemia: correlations with hematologic findings and outcome. Blood 1996; 87: 3135–3142.

  12. Rano A, Agusti C, Jiminez P, Angrill J, Benito N, Danès C et al. Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures. Thorax 2001; 122: 253–261.

    Google Scholar 

  13. Saito H, Anaissie EJ, Morice RC, Dekmezian R, Bodey GP . Bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in patients with acute leukemia. Chest 1994; 94: 745–749.

    Article  Google Scholar 

  14. Mayaud C, Cadranel J . A persistent challenge: the diagnosis of respiratory disease in the non-AIDS immunocompromised host. Thorax 2000; 55: 511–517.

    Article  CAS  Google Scholar 

  15. Cornet M, Fleury L, Maslo C, Bernard G, Brüker G, the Invasive Aspergillosis Surveillance Network of the Assistance Publique-Hôpitaux de Paris. Epidemiology of invasive aspergillosis in France: a six-year multicentric survey in the greater Paris area. J Hosp Infect 2002; 51: 288–296.

    Article  CAS  Google Scholar 

  16. Irwin RS, Erickson AD, Pratter MR, Corrao WM, Garrity FL, Kaemmerlen JT . Prediction of tracheobronchial colonization in current cigarette smokers with chronic obstructive bronchitis. J Infect Dis 1982; 145: 234–241.

    Article  CAS  Google Scholar 

  17. Zalacain R, Sobradillo V, Amilibia J, Barron J, Achotegui V, Llorente JL . Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease. Eur Respir J 1999; 13: 343–348.

    Article  CAS  Google Scholar 

  18. Corre F, Lellouch J, Schwartz D . Smoking and leucocyte-counts. Results of an epidemiological survey. Lancet 1971; 2: 632–634.

    Article  CAS  Google Scholar 

  19. Tollerud DJ, Clark JW, Brown LM, Mann DL, Neuland CY, Pankiw-Trost LK et al. The effects of cigarette smoking on T cells subsets. A population-based survey of healthy Caucasians. Am Rev Respir Dis 1989; 139: 194–198.

    Article  CAS  Google Scholar 

  20. Campisi R, Czernin J, Schöder H, Sayre JW, Marengo FD, Phelps ME et al. Effects of long-term on myocardial blood flow coronary vasomotion, and vasodilatator capacity. Circulation 1998; 98: 119–125.

    Article  CAS  Google Scholar 

  21. Madsen MM, Bottcher M, Toftegaard Nielson T, Czernin J . Altered regulation of the microcirculation in younger smokers. Cardiology 2000; 94: 91–98.

    Article  CAS  Google Scholar 

  22. Gandini C, Castoldi AF, Candura SM, Locatelli C, Butera R, Priori S et al. Carbon monoxide cardiotoxicity. J Toxicol Clin Toxicol 2001; 39: 35–44.

    Article  CAS  Google Scholar 

  23. Wang CZ, Li A, Yang ZC . The pathophysiology of carbon monoxide poisoning and acute respiratory failure in a sheep model with smoke inhalation injury. Chest 1990; 97: 736–742.

    Article  CAS  Google Scholar 

  24. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 2001; 344: 481–487.

    Article  CAS  Google Scholar 

  25. Menichetti F, Del Favero A, Martino P, Bucaneve G, Micozzi A, Girmenia C et al. Itraconazol oral solution as prophylaxis for fungal infections in neutropenic patients with hematologic malignancies: a randomized, placebo-controlled, double-blind multicentric trial. Clin Infect Dis 1999; 28: 250–255.

    Article  CAS  Google Scholar 

  26. Morgenstern GR, Prentice AG, Prentice HG, Ropner JE, Schey SA, Warnock DW . A randomized controlled trial of itraconazole versus fluconazole for the prevention of fungal infections in patients with haematological malignancies. Br J Haematol 1999; 105: 901–911.

    Article  CAS  Google Scholar 

  27. Heussel CP, Kauczor HU, Heussel GE, Fisher B, Begrich M, Mildenberger P et al. Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. J Clin Oncol 1999; 17: 796–805.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hematology, Hôtel-Dieu, Paris, France

    D Chaoui, O Legrand, R Peffault de Latour, L Sanhes & J-P Marie

  2. Department of Respiratory and Critical Care Medicine, Hôtel-Dieu, Paris, France

    N Roche, A Lefebvre, G Huchon & A Rabbat

  3. Department of Microbiology, Hôtel-Dieu, Paris, France

    M Cornet

Authors
  1. D Chaoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O Legrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N Roche
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M Cornet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Lefebvre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R Peffault de Latour
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L Sanhes
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G Huchon
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J-P Marie
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A Rabbat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Rabbat.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chaoui, D., Legrand, O., Roche, N. et al. Incidence and prognostic value of respiratory events in acute leukemia. Leukemia 18, 670–675 (2004). https://doi.org/10.1038/sj.leu.2403270

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.leu.2403270

Keywords

This article is cited by

Search

Advanced search

Quick links