Hino K, Iguchi K, Sato S, Kawakami K, Ueno H, Akimoto Y, Nakamaki T, Ishiyama T, Suzuki K, Tomoyasu S
Department of Hematology, Showa University School of Medicine.
Rinsho Ketsueki. 1991 Aug;32(8):831-7.
Ten patients with severe hematologic malignancies (four with acute leukemia, three with multiple myeloma, one with prolymphocytic leukemia, one with malignant lymphoma and one with blastic crisis of chronic myelogenous leukemia) developed respiratory failure during the period between April 1986 and May 1990. Clinically, the patients manifested high-fever, dyspnea refractory to oxygen therapy, diffuse pulmonary rales and severe hypoxemia without evidence of cardiogenic pulmonary edema. Chest roentgenograms displayed diffuse alveolar infiltrates. Respiratory failure occurred as early as 48 hours and as late as 66 days after the administration of intensive anti-neoplastic chemotherapy. At that time leukocyte count was between 100/microliters and 54,900/microliters. Marked leukocytosis was observed in two patients with AML and PLL. Respiratory failure was preceded by sepsis in one patient with AML and by pneumonia in nine patients. DIC was diagnosed in four patients. All patients treated with high dose methyl prednisolone (mPSL) within 12 hours after the onset of respiratory failure. Only one patient required assisted ventilation. High dose mPSL had significant effect on seven of ten patients. But three patients died from progressive respiratory failure, sepsis, pneumonia and multi-organ failure.
1986年4月至1990年5月期间，10例严重血液系统恶性肿瘤患者（4例急性白血病、3例多发性骨髓瘤、1例原淋巴细胞白血病、1例恶性淋巴瘤和1例慢性粒细胞白血病急变期）发生呼吸衰竭。临床上，患者表现为高热、氧疗难以纠正的呼吸困难、双肺弥漫性湿啰音和严重低氧血症，无心源性肺水肿证据。胸部X线片显示弥漫性肺泡浸润。呼吸衰竭最早在强化抗肿瘤化疗给药后48小时出现，最晚在66天后出现。当时白细胞计数在100/微升和54,900/微升之间。2例急性髓系白血病和原淋巴细胞白血病患者出现明显白细胞增多。1例急性髓系白血病患者呼吸衰竭前发生败血症，9例患者发生肺炎。4例患者诊断为弥散性血管内凝血（DIC）。所有患者在呼吸衰竭发作后12小时内接受大剂量甲泼尼龙（mPSL）治疗。仅1例患者需要辅助通气。大剂量mPSL对10例患者中的7例有显著效果。但3例患者死于进行性呼吸衰竭、败血症、肺炎和多器官功能衰竭。
