Abstract
Purpose
Intensive therapy regimens in patients with acute myeloid leukemia (AML) frequently result in sepsis and septic shock. In this study, we investigated the prognostic outcome of AML patients requiring intensive care treatment due to severe sepsis or septic shock.
Design
We present a retrospective cohort study in a medical intensive care unit (ICU) of a university hospital that serves as a tertiary care center.
Materials and methods
Here we present data from 44 AML patients of our ICU with 29 requiring invasive mechanical ventilation due to sepsis and compared multiple clinical and laboratory parameters of ICU survivors and non-survivors.
Results
Mean age was 59.5 years, the overall mortality rate was 41 % (18/44), and the mortality rate among patients who received mechanical ventilation was 55 % (16/29). The mortality rate among younger patients (aged 60 years or less) was 17 % (3/18), while 58 % of the older patients died (15/26). The mortality rate among younger patients who received mechanical ventilation was 23 % (3/13) compared with 81 % (13/16) of the older patients. The mean invasive ventilation time was 415 h in non-survivors compared with 667 h in survivors. No differences could be identified between survivors and non-survivors, concerning multiple laboratory parameters or AML prognostic and therapeutic parameters; our analysis, however, confirmed a statistically significant difference in the patients’ age.
Conclusions
In previous studies, age was one of the most important prognostic factors in AML patients receiving mechanical ventilation due to severe sepsis or septic shock. In spite of improvements in diagnostic and treatment over the last couple of years, our study indicates that this fact still is true. However, the overall outcome has improved over the years due to improvements in intensive care medicine.
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References
Bene MC, Castoldi G, Knapp W et al (1995) Proposals for the immunological classification of acute leukemias: European group for the immunological characterization of Leukemias (EGIL). Leukemia 9:1783–1786
Bloomfield CD, Lawrence D, Byrd JC et al (1998) Frequency of prolonged remission duration after high-dose cytarabine intensification in acute myeloid leukemia varies by cytogenetic subtype. Cancer Res 58:4173–4179
Buccisano F, Maurillo L, Del Principe MI et al (2012) Prognostic and therapeutic implications of minimal residual disease detection in acute myeloid leukemia. Blood 119:332–341
Cheson BD, Bennett JM, Kopecky KJ et al (2003) Revised recommendations of the international working group for diagnosis, standardization of response criteria, treatment outcomes, and reporting standards for therapeutic trials in acute myeloid leukemia. J Clin Oncol 21:4642–4649
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al (2012) Surviving sepsis campaign guidelines committee including the pediatric subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med 41:580–637
Döhner H, Estey EH, Amadori S et al (2010) Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood 115:453–474
Epner DE, White P, Krasnoff M, Khanduja S, Kimball KT, Knaus WA (1996) Outcome of mechanical ventilation for adults with hematologic malignancy. J Investig Med 44:254–260
Estey EH (2012) Acute myeloid leukemia: 2012 update on diagnosis, risk stratification and management. Am J Hematol 87:89–99
Leung W, Pui CH, Coustan-Smith E et al (2012) Detectable minimal residual disease before hematopoietic cell transplantation is prognostic but does not preclude cure for children with very-high-risk leukemia. Blood 120:468–472
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D et al (2003) SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31:1250–1256
Mrozek K, Marcucci G, Nicolet D et al (2012) Prognostic significance of the European leukemianet standardized system for reporting cytogenetic and molecular alterations in adults with acute myeloid leukemia. J Clin Oncol 30:4515–4523
Othus M, Kantarjian H, Petersdorf S et al (2012) Declining rates of treatment-related mortality in patients with newly diagnosed acute myeloid leukemia (AML) given “intensive” induction regimens: a report from the Southwest oncology group (SWOG) and MD Anderson cancer center (MDA). ASH annual meeting abstracts; 120:129
Patel JP, Gonen M, Figueroa ME et al (2012) Prognostic relevance of integrated genetic profiling in acute myeloid Leukemia. N Engl J Med 366:1079–1089
Peters SG, Meadows JA, Gracey DR (1988) Outcome of respiratory failure in hematologic malignancy. Chest 94:99–102
Roze des Ordons AL, Chan K, Mirza I, Townsend DR, Bagshaw SM (2010) Clinical characteristics and outcomes of patients with acute myelogenous leukemia admitted to intensive care: a case-control study. BMC Cancer 10:516
Swerdlow SH, Campo E, Harris NL et al (2008) WHO classification of tumors of haematopoietic and lymphoid tissues. International Agency for Research on Cancer, Lyon
Tremblay LN, Hyland RH, Schouten BD, Hanly PJ (1995) Survival of acute myelogenous leukemia patients requiring intubation/ventilatory support. Clin Invest Med 18:19–24
Vardiman JW, Thiele J, Arber DA et al (2009) The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood 114:937–951
Walter RBOM, Borthakur G, Ravandi F et al (2011a) Prediction of early death after induction therapy for newly diagnosed acute myeloid leukemia with pretreatment risk scores: a novel paradigm for treatment assignment. J Clin Oncol 29:4417–4423
Walter RB, Gooley TA, Wood B et al (2011b) Impact of pretransplantation minimal residual disease, as detected by multiparametric flow cytometry, on outcome of myeloablative hematopoietic cell transplantation for acute myeloid leukemia. J Clin Oncol 29:1190–1197
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Christoph Sippel and Young Kim have contributed equally to this work.
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Sippel, C., Kim, Y., Wallau, A. et al. AML versus ICU: outcome of septic AML patients in an intensive care setting. J Cancer Res Clin Oncol 141, 1645–1651 (2015). https://doi.org/10.1007/s00432-015-1955-9
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DOI: https://doi.org/10.1007/s00432-015-1955-9