急性髓系白血病诱导治疗期间的肺部浸润：我们了解多少？

Pulmonary infiltrates in acute myeloid leukemia during induction treatment: how much do we know?

机构信息

Departments of *Hematology and Oncology †Radiation Oncology ‡Pathology, Oakland University William Beaumont School of Medicine, William Beaumont Hospital, Royal Oak, MI.

出版信息

Am J Clin Oncol. 2014 Aug;37(4):377-83. doi: 10.1097/COC.0b013e31827b4702.

DOI:10.1097/COC.0b013e31827b4702

PMID:23357975

Abstract

BACKGROUND

During induction treatment, acute myeloid leukemia patients may develop pulmonary infiltrates due to infectious or noninfectious etiologies. The risk association and the clinical outcome of such pulmonary infiltrates are poorly characterized in the literature.

METHODS

We retrospectively reviewed 363 cases of acute myeloid leukemia patients who received induction therapy as inpatients over a period of 11 years at William Beaumont Health System. Of these 363 patients, 120 developed pulmonary infiltrates during induction therapy, those patients were divided into 2 groups based on distribution of the infiltrate presenting as localized or diffuse in nature. Data on patients characteristics, leukemia subtype, cytogenetic risk, microorganism type, white blood cell count at diagnosis, neutrophil count at the time the infiltrate was reported, response to antibiotic and/or antifungal therapy, using respiratory support, and mortality rate were retrieved through chart review.

RESULTS

Thirty-three percent of patients developed pulmonary infiltrates during their induction therapy. Sixty-three patients (52.5%) had a localized infiltrates and 57 patients (47.5%) had diffuse infiltrates. Of the 120 patients with pulmonary infiltrates, 48 (40%) had at least 1 pathogenic microorganism identified, and 58 (48.7%) required intubation and ventilatory support. Patients with localized pulmonary infiltrates were more likely to have positive pathogenic microorganisms (68.3% vs. 8.8%, P<0.001), to be neutropenic (96.8% vs. 21%, P<0.001), and tended to have potentially reversible infiltrates after treatment (87.3% vs. 21%, P<0.001). Whereas patients with diffuse infiltrates were more like to require intubation (78.9% vs. 21%, P<0.001), to have leukocytosis (white blood cell >100 billions/L) at diagnosis (54.4% vs. 0%, P<0.001), and had a higher mortality rate (70.2% vs. 9.5%, P<0.001).

CONCLUSIONS

The radiologic patterns of pulmonary infiltrates showed specific etiological and prognostic associations. Diffuse infiltrates are an unfavorable characteristic with overall dismal outcome.

摘要

背景

在诱导治疗期间，急性髓系白血病患者可能因感染或非感染性病因而出现肺部浸润。然而，此类肺部浸润的风险关联和临床结局在文献中描述甚少。

方法

我们回顾性分析了在 11 年期间于威廉博蒙特健康系统接受住院诱导治疗的 363 例急性髓系白血病患者。在这 363 例患者中，120 例在诱导治疗期间出现肺部浸润，根据浸润的分布，将这些患者分为局限性或弥漫性浸润两组。通过病历回顾，检索患者特征、白血病亚型、细胞遗传学风险、微生物类型、诊断时的白细胞计数、报告浸润时的中性粒细胞计数、对抗生素和/或抗真菌治疗的反应、使用呼吸支持以及死亡率等数据。

结果

33%的患者在诱导治疗期间出现肺部浸润。63 例（52.5%）患者为局限性浸润，57 例（47.5%）患者为弥漫性浸润。在 120 例肺部浸润患者中，48 例（40%）至少有 1 种致病微生物被确定，58 例（48.7%）需要插管和通气支持。局限性肺部浸润患者更可能有阳性致病微生物（68.3% vs. 8.8%，P<0.001），中性粒细胞减少症（96.8% vs. 21%，P<0.001），且治疗后浸润有潜在可逆转的趋势（87.3% vs. 21%，P<0.001）。而弥漫性浸润患者更需要插管（78.9% vs. 21%，P<0.001），诊断时白细胞增多（白细胞>100 亿/L）（54.4% vs. 0%，P<0.001），死亡率更高（70.2% vs. 9.5%，P<0.001）。