Outcomes in critically ill chronic lymphocytic leukemia patients
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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.
KeywordsLeukemia 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.
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