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Pneumonia in acute leukemia patients during induction therapy: experience in a single institution
Giorgina Specchia1, Domenico Pastore, Paola Carluccio
1Hematology Section, Department DIMIMP, University of Bari, Piazza Giulio Cesare 11, Bari, 70124 Italy. emadhba@cimedoc.uniba.it
Abstract:
Pneumonia is still a complication leading to high morbidity and mortality rates in acute leukemia (AL) patients. To evaluate the incidence, risk factors and outcome of pneumonia in a single institution we retrospectively studied 288 patients observed between 1994 and 2000, affected by AL (218 acute myeloblastic leukemia and 70 acute lymphoblastic leukemia [ALL]) treated with an anthracycline-containing induction regimen. Of 288 patients, 80 (27.7%) developed pneumonia: 67/80 had acute myelogenous leukemia (AML) and 13/80 had ALL. At univariate analysis only advanced age correlated with the risk of pneumonia (P < 0.001). Of the 80 pneumonia cases, 25 (31.2%) were microbiologically documented and 65 (68.8%) were clinically demonstrated; pneumonia responded to treatment in 44/80 (55%) patients; among the patients with positive outcome of their pneumonia 33/44 (75%) achieved complete remission whereas only 2/36 (5%) patients with a negative outcome achieved complete remission. At multivariate analysis the determinants of positive outcome of pneumonia were younger age (P < 0.05), the achievement of complete remission (P < 0.005) and the recovery of neutrophils (P < 0.005).
Insights
Pneumonia is a significant risk for acute leukemia (AL) patients, impacting treatment outcomes. Younger age, achieving complete remission, and neutrophil recovery improve pneumonia outcomes in these patients.
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- Pneumonia presents a substantial challenge, contributing to high morbidity and mortality rates in patients with acute leukemia (AL).
- Understanding pneumonia's incidence, risk factors, and outcomes is crucial for improving patient care in acute leukemia.
- Anthracycline-based induction regimens are standard for acute leukemia, but their association with complications like pneumonia requires investigation.
Purpose of the Study:
- To retrospectively evaluate the incidence, risk factors, and outcomes of pneumonia in acute leukemia patients.
- To identify predictors of pneumonia development and treatment response in this vulnerable patient population.
- To analyze the relationship between pneumonia outcomes and complete remission rates in acute leukemia.
Main Methods:
- Retrospective analysis of 288 acute leukemia patients treated between 1994 and 2000.
- Data collection included patient demographics, leukemia type (acute myeloblastic leukemia, acute lymphoblastic leukemia), treatment regimens, and pneumonia occurrence.
- Statistical analyses, including univariate and multivariate analyses, were employed to identify risk factors and outcome determinants.
Main Results:
- Pneumonia developed in 27.7% of acute leukemia patients, with a higher incidence in acute myeloblastic leukemia.
- Advanced age was the primary risk factor for pneumonia development.
- Positive pneumonia outcomes were significantly associated with younger age, achievement of complete remission, and neutrophil recovery.
Conclusions:
- Pneumonia remains a critical complication in acute leukemia patients, influencing treatment success.
- Younger age, successful achievement of complete remission, and neutrophil recovery are key factors for a positive pneumonia outcome.
- Further research into prophylactic and therapeutic strategies for pneumonia in acute leukemia is warranted.