Incidence and outcome of pneumonia in patients with acute leukemia receiving first induction therapy with anthracycline-containing regimens

Background and Objectives. Even though the risk of pneumonia Is higher in p atients with advanced disease,the potential risk of death is particularly r elevant during induction therapy, when patients can be potentially cured of their hematologic disease: our study war aimed at evaluating the risk and outcome of pneumonia in these patients. Design and Methods. We retrospectively studied all 458 patients affected by acute leukemia receiving an anthracycline-containing induction regimen in the years 1984-1989. Results. Of the 458 patients, 109 (23.8%) developed pneumonia: 91 had acute myelogenous leukemia (AML) and 18 had acute lymphoblastic leukemia (ALL). At univariate analysis, advanced age, AML and total blast count significant ly correlated with the risk of pneumonia. At multivariate analysis, only ag e (p< 0.0001) and total blast count (p=0.002) retained their prognostic sig nificance. Pneumonia responded to treatment In 67 (61.5%) patients, while 4 2 (38.5%) patients died. Among patients with pneumonia, 51 (46.8%) patients achieved a complete remission: 9/18 AU and 42/91 AML. At univariate analys is, the most significant determinant of a positive outcome was the achievem ent of complete remission; a higher absolute neutrophil count at the onset of pneumonia, the absence of rales, a single infiltrate and the absence of microbiological demonstration of infection were also related to a positive outcome. At multivariate analysis, the achievement of complete remission an d, with borderline significance, a single infiltrate maintained their progn ostic value. Interpretation and Conclusions. Pneumonia remains one of the most relevant risks of morbidity and mortality during induction therapy for acute leukemi a. A fatal outcome is associated. in most cases, with a failure to achieve remission of leukemia. (C) 2000, Ferrata Storti Foundation.