ICU intervention during induction chemotherapy for adult patients with newly diagnosed acute myeloid leukemia

Leuk Res. 2016 Sep;48:16-9. doi: 10.1016/j.leukres.2016.07.001. Epub 2016 Jul 7.

Abstract

We carried out a retrospective study on newly diagnosed AML patients to identify the risk factors associated with intensive care unit (ICU) intervention. One hundred and twenty consecutive AML patients were included. The median cycle of induction therapy (IT) was 2 (range 1-4). Ten patients (8%) needed ICU intervention during IT. The median time from first IT to ICU transfer was 16days (range 2-88days). Three patients required vasopressor/s, three mechanical ventilation, and four both. The cumulative probability for ICU intervention rose progressively with increasing cycles of IT received, from 2.5% during first induction to 27.5% at fourth induction. Age, sex, presentation white cell counts and coagulation profiles, cytogenetics, pre-chemotherapy ventricular ejection fractions, and prior chemoradiation were not risk factors. Univariate analysis identified a history of inflammatory bowel disease (IBD) (p=0.004) (RR=5.7; p=0.03) and positive blood cultures (BC) (p=0.03) (RR=3; p=0.06) as significant risks. Multivariate analysis found a history of IBD as the only significant factor (p=0.03), while positive BC (p=0.1) trending towards significance. AML patients with a history of IBD and positive BC are at increased risks for ICU intervention during IT.

Keywords: AML; IBD; ICU; Positive blood cultures.

MeSH terms

  • Adult
  • Aged
  • Female
  • Hematologic Tests
  • Humans
  • Induction Chemotherapy
  • Inflammatory Bowel Diseases
  • Intensive Care Units / statistics & numerical data*
  • Leukemia, Myeloid, Acute / complications
  • Leukemia, Myeloid, Acute / diagnosis*
  • Leukemia, Myeloid, Acute / therapy
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Young Adult