Abstract
Infection, hemorrhage and adult respiratory distress syndrome (ARDS) are pulmonary complications occurring after remission induction therapy for acute leukemia. The aim of this study was to analyze the incidence of these causes by serial roentgenogram, clinical, microbiological and laboratory tests in 21 patients (pts) with relapsed acute leukemia (18 x myeloid, 3 x lymphoblastic), an AML-pt (acute myeloid leukemia) suffering from secondary leukemia, and three pts with primary refractory leukemia following treatment with intermediate (IM) and high-dose cytosine arabinoside (HD-Ara C), in combination with amsacrine (AMSA) (n = 19), etoposide (VP 16) (n = 5) or Mitoxantrone (n = 1). Eleven out of 25 pts developed pulmonary complications, one of them with massive hemoptysis and roentgenographic signs of pulmonary bleecling, one suffering from protracted shock after a tumor lysis syndrome, two pts showing symptoms of a cardiogenic pulmonary edema complicating severeCandida pneumonia in one case and legionnaires’ disease in the other. Seven of the eleven pts had a noncardiogenic pulmonary edema with respiratory failure 1–14 days after cessation of induction or consolidation therapy. In six of the seven, there were no signs of cardiogenic, infectious or metabolic reasons, inclucling fluid overload, for the pulmonary edema, one had as a contributing factor aCandida infection of the lung. Three of the seven patients recovered, four died (two following IM and two after HD-Ara C). Other adverse side effects, clearly attributable to HD-Ara C, included delirious state (n = 3), generalized erythema (n = 3), acute pancreatitis (n = 2), acute abdomen (n = 1) and conjunctivitis in almost all patients. In conclusion, the most frequent (7/25) and serious complication following HD-Ara C treatment in our series was a toxic, non-cardiogenic edema of the lung. In our opinion, the clinical evidence for this type of toxicity might have been misinterpreted in many instances in the past, and it should draw close attention in the future.
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Jehn, U., Göldel, N., Rienmüller, R. et al. Non-cardiogenic pulmonary edema complicating intermediate and high-dose Ara C treatment for relapsed acute leukemia. Med. Oncol. & Tumor Pharmacother. 5, 41–47 (1988). https://doi.org/10.1007/BF03003180
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DOI: https://doi.org/10.1007/BF03003180