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Evaluating pulmonary complications in childhood acute leukemias
Barş Erdur1, Sebnem Yilmaz, Hale Oren
1Department of Pediatric Hematology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
Summary:
We evaluated the frequency, etiologic factors, outcome, and the comorbid conditions affecting the morbidity and mortality of pulmonary complications in acute childhood leukemia. Sixty-six (40.4%) out of 163 patients developed 79 pulmonary complications. Infectious etiology was the leading cause (92.4%). The most identified infectious agents were Gram (-) bacteria, followed by fungi. Acute respiratory distress syndrome, leukostasis, lymphomatoid granulomatosis, pulmonary edema, and pneumothorax were among the noninfectious causes. The pulmonary complications in the induction and consolidation phase of leukemia therapy were more severe and the mortality rate was higher. Tachypnea, shock, oxygen and mechanical ventilation requirement, disseminated intravascular coagulation, involvement of other organs or systems, cytopenias, requirement of modification in antimicrobial drugs were found to be related with increased mortality risk. The mortality rate of pulmonary complications was 8.9%. Pulmonary infections in the maintenance phase of the therapy were frequently treated with oral antibiotics, and they were generally rapidly taken under control. In conclusion, pulmonary complications are frequent in children with acute leukemia, and early diagnosis and appropriate management are important to avoid mortality owing to pulmonary complications, especially in neutropenic patients receiving induction or consolidation phase of chemotherapy.
Insights
Pulmonary complications are common in children with acute leukemia, with infections being the primary cause. Early diagnosis and management are crucial, especially during intensive chemotherapy phases, to reduce mortality risks.
Area of Science:
- Pediatric Oncology
- Pulmonology
- Infectious Diseases
Background:
- Pulmonary complications are a significant concern in pediatric acute leukemia patients.
- These complications contribute to morbidity and mortality, necessitating a thorough understanding of their causes and outcomes.
Purpose of the Study:
- To investigate the frequency, causes, outcomes, and associated factors of pulmonary complications in children with acute leukemia.
- To identify risk factors for mortality related to these complications.
Main Methods:
- Retrospective evaluation of 163 pediatric acute leukemia patients.
- Analysis of pulmonary complication incidence, etiology (infectious and non-infectious), and patient outcomes.
- Identification of factors associated with increased mortality risk.
Main Results:
- Pulmonary complications occurred in 40.4% of patients (79 events in 66 patients).
- Infectious causes predominated (92.4%), with Gram-negative bacteria and fungi being most common.
- Non-infectious causes included acute respiratory distress syndrome and leukostasis.
- Complications during induction/consolidation phases were more severe with higher mortality (8.9%).
- Tachypnea, shock, mechanical ventilation, DIC, multi-organ involvement, cytopenias, and altered antimicrobial therapy predicted higher mortality.
Conclusions:
- Pulmonary complications are frequent and potentially fatal in pediatric acute leukemia.
- Prompt diagnosis and management are vital, particularly for neutropenic patients undergoing induction or consolidation chemotherapy.
- Understanding risk factors aids in optimizing patient care and reducing mortality.
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