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 value
Age (years) >60
 ≤60 998
 767 32
 21 3%
 3% 0.569 
Diagnosis M3
 M4-M5
 others 109
 319
 1337 812
 33 7%
 4%
 2% 0.011 
Platelet (×109/L) ≥20
 <20 1475
 290 43
 10 3%
 3% 0.624 
WBC (×109/L) >10
 ≤10 653
 1112 32
 21 5%
 2% 0.000 
Performance status 0–2
 3–4 1662
 103 44
 9 3%
 9% 0.000 
Serum CR (mg/dl) <1.5
 >1.5 1622
 140 46
 7 3%
 5% 0.150 
HGB (g/dl) <8.0
 >8.0 872
 893 32
 21 4%
 2% 0.105 
Infection No
 Yes 1218
 494 32
 21 3%
 3% 0.089 
parameterscategoryTotal No.Pulmonary Hemorrhage(%)P value
Age (years) >60
 ≤60 998
 767 32
 21 3%
 3% 0.569 
Diagnosis M3
 M4-M5
 others 109
 319
 1337 812
 33 7%
 4%
 2% 0.011 
Platelet (×109/L) ≥20
 <20 1475
 290 43
 10 3%
 3% 0.624 
WBC (×109/L) >10
 ≤10 653
 1112 32
 21 5%
 2% 0.000 
Performance status 0–2
 3–4 1662
 103 44
 9 3%
 9% 0.000 
Serum CR (mg/dl) <1.5
 >1.5 1622
 140 46
 7 3%
 5% 0.150 
HGB (g/dl) <8.0
 >8.0 872
 893 32
 21 4%
 2% 0.105 
Infection No
 Yes 1218
 494 32
 21 3%
 3% 0.089 
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The 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.

Topics:
chemotherapy regimen, leukemia, myelocytic, acute, pulmonary alveolar hemorrhage, remission induction, chemotherapy, neoadjuvant, cytokine, hemoglobin, infections, leukemia, neoadjuvant therapy

Disclosures: No relevant conflicts of interest to declare.

Author notes

Corresponding author

2008, The American Society of Hematology
2008
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