Pneumonia During Remission Induction Chemotherapy in Patients With Acute Leukemia

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

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Disease
  • Adult
  • Age Factors
  • Aged
  • Cohort Studies
  • Female
  • Humans
  • Hypoalbuminemia
  • Induction Chemotherapy*
  • Leukemia / complications*
  • Leukemia / drug therapy
  • Leukemia, Myeloid, Acute / complications
  • Leukemia, Myeloid, Acute / drug therapy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myelodysplastic Syndromes / complications
  • Myelodysplastic Syndromes / drug therapy
  • Neutropenia
  • Opportunistic Infections / complications*
  • Opportunistic Infections / mortality
  • Pneumonia / complications*
  • Pneumonia / mortality
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / complications
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
  • Proportional Hazards Models
  • Remission Induction
  • Retrospective Studies
  • Risk Factors
  • Thrombocytopenia