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. 2013 Oct;10(5):432-40.
doi: 10.1513/AnnalsATS.201304-097OC.

Pneumonia during remission induction chemotherapy in patients with acute leukemia

Javier Barreda Garcia  1 , Xiudong Lei, William Wierda, Jorge E Cortes, Burton F Dickey, Scott E Evans, David E Ost
Affiliations

Pneumonia during remission induction chemotherapy in patients with acute leukemia

Javier Barreda Garcia et al. Ann Am Thorac Soc. 2013 Oct.

Abstract

Background: Pneumonia is a major cause of death during induction chemotherapy for acute leukemia. The purpose of this study was to quantify the incidence, risk factors, and outcomes of pneumonia in patients with acute leukemia.

Methods: We conducted a retrospective cohort study of 801 patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or acute lymphocytic leukemia (ALL) who underwent induction chemotherapy.

Measurements and main results: Pneumonia was present at induction start in 85 patients (11%). Of the 716 remaining patients, 148 (21%) developed pneumonia. The incidence rate of pneumonia was higher in MDS and AML than in ALL (0.013 vs. 0.008 vs. 0.003 pneumonias per day, respectively; P < 0.001). In multivariate analysis, age greater than or equal to 60 years, AML, low platelet count, low albumin level, neutropenia, and neutrophil count greater than 7,300 were risk factors. The case fatality rate of pneumonia was 17% (40 of 233). Competing risk analysis demonstrated that in the absence of pneumonia, death was rare: 28-day mortality was 6.2% for all patients but only 1.26% in those without pneumonia. Compared with patients without pneumonia, patients with pneumonia had more intensive care unit days, longer hospital stays, and 49% higher costs (P < 0.001).

Conclusions: Pneumonia after induction chemotherapy for acute leukemia continues to be common, and it is the most important determinant of early mortality after induction chemotherapy. Given the high incidence, morbidity, mortality, and cost of pneumonia, interventions aimed at prevention are warranted in patients with acute leukemia.

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Figures

Figure 1.
Figure 1.
(A) Pneumonia syndrome incidence during induction chemotherapy in patients with acute leukemia. (B) Hazard function by type of leukemia. There is left and right truncation of the curves because the hazard functions are calculated over the range of observed failure times for each group using a weighted kernel-density estimate. ALL = acute lymphoblastic leukemia; AML = acute myeloid leukemia; MDS = acute myelodysplastic syndrome.
Figure 2.
Figure 2.
Extended Cox model plot of time to death during induction chemotherapy for acute leukemia. Patients with pneumonia syndrome had an increased risk of death (log rank P < 0.001).
See this image and copyright information in PMC

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