Supportive Care in Cancer

, Volume 21, Issue 7, pp 1885–1891 | Cite as

Outcomes in critically ill chronic lymphocytic leukemia patients

  • Aliénor Xhaard
  • Loic Epelboin
  • David Schnell
  • François Vincent
  • Vincent Levy
  • Marion Malphettes
  • Élie Azoulay
  • Michaël DarmonEmail author
Original Article



Although recent studies have demonstrated an improvement in the prognosis of critically ill cancer patients, little is known regarding the prognosis of patients with non-aggressive underlying malignancies. The aims of this study were to assess the prognosis of critically ill patients with chronic lymphocytic leukemia (CLL) and to evaluate risk factors for hospital mortality.


In retrospective mono-center cohort study, consecutive adult patients with CLL requiring ICU admission from 1997 to 2008 were included.


Sixty-two patients of 67 years (62–75) were included. Median time interval between CLL diagnosis and ICU admission was 6.7 years (2.6–10.8). Nine patients (15 %) had stage C disease at the time of ICU admission, and seven patients (11 %) had Richter syndrome. Most ICU admissions were related to bacterial or fungal pulmonary infections (n = 47; 76 %). ICU, in-hospital, and 90-day mortality were 35 % (n = 22), 42 % (n = 26), and 58 % (n = 36), respectively. Only three factors were independently associated with in-hospital mortality: oxygen saturation lower than 95 % when breathing room air (odds ratio (OR) 5.80; 95 % confidence interval (CI) 1.23–27.33), need for vasopressors (OR 27.94; 95 % CI 5.37–145.4), and past history of infection (OR 6.62; 95 % CI 1.34–32.68). The final model did not change when disease-related variables (Binet classification, Richter syndrome, long-term steroids) or treatment-related variables (fludarabine, rituximab, or alemtuzumab) were included.


Acute pulmonary infections remain the leading cause of ICU admission in patients with CLL. The severity at ICU admission and past history of infection were the only factors associated with hospital mortality. Neither disease characteristics nor previous cancer treatments were associated with outcome.


Leukemia Lymphocytic Chronic B cell ICU Vasoconstrictor agents Fludarabine Alemtuzumab 



This work was supported by a grant from the Assistance-Publique Hôpitaux de Paris (AOM 04139) and the French Society for Intensive Care Medicine.

Conflict of interest

None of the authors had any conflict of interest related to this manuscript to report. MD had full access to the data, take full responsibility for the statistical analysis and the accuracy of the results report. The journal is allowed to access and review these data if requested.


  1. 1.
    Carlon GC (1988) Admitting cancer patients to the intensive care unit. Crit Care Clin 4:183–191PubMedGoogle Scholar
  2. 2.
    Lloyd-Thomas AR, Dhaliwal HS, Lister TA et al (1986) Intensive therapy for life-threatening medical complications of haematological malignancy. Intensive Care Med 12:317–324PubMedCrossRefGoogle Scholar
  3. 3.
    Groeger JS, Lemeshow S, Price K et al (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16:761–770PubMedGoogle Scholar
  4. 4.
    Afessa B, Tefferi A, Hoagland HC et al (1992) Outcome of recipients of bone marrow transplants who require intensive-care unit support. Mayo Clin Proc 67:117–122PubMedCrossRefGoogle Scholar
  5. 5.
    Darmon M, Azoulay E (2009) Critical care management of cancer patients: cause for optimism and need for objectivity. Curr Opin Oncol 21:318–326PubMedCrossRefGoogle Scholar
  6. 6.
    Azoulay E, Soares M, Darmon M et al (2011) Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care 1:5PubMedCrossRefGoogle Scholar
  7. 7.
    Soares M, Caruso P, Silva E et al (2010) Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med 38:9–15PubMedCrossRefGoogle Scholar
  8. 8.
    Benoit DD, Vandewoude KH, Decruyenaere JM et al (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31:104–112PubMedCrossRefGoogle Scholar
  9. 9.
    Peters SG, Meadows JA 3rd, Gracey DR (1988) Outcome of respiratory failure in hematologic malignancy. Chest 94:99–102PubMedCrossRefGoogle Scholar
  10. 10.
    Brenner H (2002) Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet 360:1131–1135PubMedCrossRefGoogle Scholar
  11. 11.
    Chiorazzi N, Rai KR, Ferrarini M (2005) Chronic lymphocytic leukemia. N Engl J Med 352:804–815PubMedCrossRefGoogle Scholar
  12. 12.
    Wierda WG (2006) Current and investigational therapies for patients with CLL. Hematology Am Soc Hematol Educ Program 285–94Google Scholar
  13. 13.
    Morrison VA (2010) Infectious complications of chronic lymphocytic leukaemia: pathogenesis, spectrum of infection, preventive approaches. Best Pract Res Clin Haematol 23:145–153PubMedCrossRefGoogle Scholar
  14. 14.
    Lepretre S, Aurran T, Mahé B et al (2012) Excess mortality following FCCam treatment in previously untreated patients with CLL: safety and efficacy in a randomized, multicenter, phase III trial. Blood. doi: 10.1182/blood-2011-07-365437
  15. 15.
    Skoetz N, Bauer K, Elter T et al (2012) Alemtuzumab for patients with chronic lymphocytic leukaemia. Cochrane Database Syst Rev 2:CD008078PubMedGoogle Scholar
  16. 16.
    Azoulay E, Thiéry G, Chevret S et al (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Med (Baltimore) 83:360–370CrossRefGoogle Scholar
  17. 17.
    Peigne V, Rusinová K, Karlin L et al (2009) Continued survival gains in recent years among critically ill myeloma patients. Intensive Care Med 35:512–518PubMedCrossRefGoogle Scholar
  18. 18.
    Binet JL, Auquier A, Dighiero G et al (1981) A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer 48:198–206PubMedCrossRefGoogle Scholar
  19. 19.
    Le Gall JR, Klar J, Lemeshow S et al (1996) The logistic organ dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 276:802–810PubMedCrossRefGoogle Scholar
  20. 20.
    Muckart DJ, Bhagwanjee S (1997) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 25:1789–1795PubMedCrossRefGoogle Scholar
  21. 21.
    Anonymous (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med 152:S77–121Google Scholar
  22. 22.
    Legrand M, Max A, Peigne V et al (2012) Survival in neutropenic patients with severe sepsis or septic shock. Crit Care Med 40:43–49PubMedCrossRefGoogle Scholar
  23. 23.
    Depuydt P, Benoit D, Vogelaers D et al (2006) Outcome in bacteremia associated with nosocomial pneumonia and the impact of pathogen prediction by tracheal surveillance cultures. Intensive Care Med 32:1773–1781PubMedCrossRefGoogle Scholar
  24. 24.
    Morrison VA (2007) Management of infectious complications in patients with chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program 332–8Google Scholar
  25. 25.
    Francis S, Karanth M, Pratt G et al (2006) The effect of immunoglobulin VH gene mutation status and other prognostic factors on the incidence of major infections in patients with chronic lymphocytic leukemia. Cancer 107:1023–1033PubMedCrossRefGoogle Scholar
  26. 26.
    Ravandi F, O’Brien S (2006) Immune defects in patients with chronic lymphocytic leukemia. Cancer Immunol Immunother 55:197–209PubMedCrossRefGoogle Scholar
  27. 27.
    Wadhwa PD, Morrison VA (2006) Infectious complications of chronic lymphocytic leukemia. Semin Oncol 33:240–249PubMedCrossRefGoogle Scholar
  28. 28.
    Molica S, Levato D, Levato L (1993) Infections in chronic lymphocytic leukemia. Analysis of incidence as a function of length of follow-up. Haematologica 78:374–377PubMedGoogle Scholar
  29. 29.
    Eichhorst BF, Busch R, Schweighofer C et al (2007) Due to low infection rates no routine anti-infective prophylaxis is required in younger patients with chronic lymphocytic leukaemia during fludarabine-based first line therapy. Br J Haematol 136:63–72PubMedCrossRefGoogle Scholar
  30. 30.
    Hensel M, Kornacker M, Yammeni S et al (2003) Disease activity and pretreatment, rather than hypogammaglobulinaemia, are major risk factors for infectious complications in patients with chronic lymphocytic leukaemia. Br J Haematol 122:600–606PubMedCrossRefGoogle Scholar
  31. 31.
    Lin TS, Donohue KA, Byrd JC et al (2010) Consolidation therapy with subcutaneous alemtuzumab after fludarabine and rituximab induction therapy for previously untreated chronic lymphocytic leukemia: final analysis of CALGB 10101. J Clin Oncol 28:4500–4506PubMedCrossRefGoogle Scholar
  32. 32.
    Schweighofer CD, Ritgen M, Eichhorst BF et al (2009) Consolidation with alemtuzumab improves progression-free survival in patients with chronic lymphocytic leukaemia (CLL) in first remission: long-term follow-up of a randomized phase III trial of the German CLL Study Group (GCLLSG). Br J Haematol 144:95–98PubMedCrossRefGoogle Scholar
  33. 33.
    Badoux XC, Keating MJ, Wang X et al (2011) Cyclophosphamide, fludarabine, alemtuzumab, and rituximab as salvage therapy for heavily pretreated patients with chronic lymphocytic leukemia. Blood 118:2085–2093PubMedCrossRefGoogle Scholar
  34. 34.
    Schellongowski P, Staudinger T, Kundi M et al (2011) Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience. Haematologica 96:231–237PubMedCrossRefGoogle Scholar
  35. 35.
    Thakkar SG, Fu AZ, Sweetenham JW, Mciver ZA et al (2008) Survival and predictors of outcome in patients with acute leukemia admitted to the intensive care unit. Cancer 112:2233–2240PubMedCrossRefGoogle Scholar
  36. 36.
    Darmon M, Azoulay E, Alberti C et al (2002) Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients. Intensive Care Med 28:1775–1780PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Aliénor Xhaard
    • 1
    • 2
  • Loic Epelboin
    • 3
  • David Schnell
    • 2
    • 4
  • François Vincent
    • 5
  • Vincent Levy
    • 6
    • 7
  • Marion Malphettes
    • 8
  • Élie Azoulay
    • 2
    • 4
  • Michaël Darmon
    • 9
    • 10
    Email author
  1. 1.Bone Marrow Transplant UnitAP-HP, Saint-Louis University HospitalParisFrance
  2. 2.Paris-7 UniversityParisFrance
  3. 3.Department of Infectious DiseaseAP-HP, Pitié-Salpetriére University HospitalParisFrance
  4. 4.Medical ICUAP-HP, Saint-Louis University HospitalParisFrance
  5. 5.Medical–Surgical ICUAP-HP, Avicenne, UniversityBobignyFrance
  6. 6.Clinical Research UnitAP-HP, Avicenne, UniversityBobignyFrance
  7. 7.Paris-13 UniversityAubervilliersFrance
  8. 8.Immuno-HematologyAP-HP, Saint-Louis University HospitalParisFrance
  9. 9.Medical–Surgical ICUSaint-Etienne UniversitySaint-EtienneFrance
  10. 10.Jacques Lisfranc Medical SchoolJean Monet UniversitySaint-EtienneFrance

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