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一名正在接受急性髓系白血病诱导化疗的患者开始进行静脉-静脉体外膜肺氧合治疗。

Initiation of venovenous extracorporeal membrane oxygenation in a patient receiving induction chemotherapy for acute myelogenous leukemia.

作者信息

Avasarala Sameer K, Qureshi Muhammad R, Waldron Madeline, Mukherjee Sudipto, Reddy Anita J

机构信息

1 Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.

2 Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.

出版信息

J Oncol Pharm Pract. 2019 Sep;25(6):1491-1496. doi: 10.1177/1078155218788735. Epub 2018 Jul 24.

Abstract

BACKGROUND

Acute respiratory failure is a leading cause of intensive care unit admission in patients with hematological malignancies; it carries a mortality rate exceeding 50%. Venovenous extracorporeal membrane oxygenation use in patients with acute hematologic malignancies concurrently receiving induction chemotherapy is not well studied.

CASE PRESENTATION

A 44-year-old male developed acute respiratory distress syndrome in the setting of newly diagnosed acute myelogenous leukemia. He underwent successful induction chemotherapy while on venovenous extracorporeal membrane oxygenation. His course was complicated by a devastating subarachnoid hemorrhage. Life support modalities were discontinued in accordance to the wishes of the family.

CONCLUSION

There is a lack of data to guide use of induction chemotherapy in patients with acute hematologic malignancies requiring venovenous extracorporeal membrane oxygenation, particularly with regard to dosing, safety, and efficacy of chemotherapeutic agents. This case highlights a potential role of venovenous extracorporeal membrane oxygenation in select young acute myelogenous leukemia patients who might benefit from this intervention and warrants further research.

摘要

背景

急性呼吸衰竭是血液系统恶性肿瘤患者入住重症监护病房的主要原因;其死亡率超过50%。急性血液系统恶性肿瘤患者在接受诱导化疗的同时使用静脉-静脉体外膜肺氧合的情况尚未得到充分研究。

病例介绍

一名44岁男性在新诊断为急性髓系白血病的情况下发生了急性呼吸窘迫综合征。他在接受静脉-静脉体外膜肺氧合治疗的同时成功接受了诱导化疗。他的病程因严重的蛛网膜下腔出血而复杂化。根据家属的意愿,停止了生命支持措施。

结论

缺乏数据来指导需要静脉-静脉体外膜肺氧合的急性血液系统恶性肿瘤患者使用诱导化疗,特别是关于化疗药物的剂量、安全性和疗效。本病例突出了静脉-静脉体外膜肺氧合在某些可能从该干预措施中获益的年轻急性髓系白血病患者中的潜在作用,值得进一步研究。

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