Role of the intensive care in treatment of patients with acute myeloid leukemia


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Abstract

Aim. Remission induction can be associate, with the life threatening complications and transfer to ICU of de novo acute myeloid leukemia (AML) patients (pts). We evaluate influence of transfer to ICU and life threatening complication on early mortality and long - tram survival of de novo AML pts. Materials and methods. Retrospective study. All de novo AML pts younger than 60 years old admitted in the National Research Center for Hematology from 2013 to 2016 years were enrolled in the study. Patients were divided into 2 groups: pts who were required ICU admission during remission induction (ICU-pts) and pts who did not require ICU admission and received chemotherapy only in hematology ward (non-ICU pts). The reasons for ICU admissions and results of life support were analyzed. Overall survival (OS) were assessed by the Kaplan-Meier method, long rank value p<0.05 consider as significant. Univariate analysis was performed with χ2 tests or Fisher's exact tests for categorical variables to find an independent ICU mortality predictor. Results. In total 76 pts were included. 37% of pts required admission to ICU. Reasons for the ICU admissions were: acute respiratory failure (50%), septic shock (14.3%), cerebrovascular accident (17.9%), emergency caesarian section (10.7%), cardiac arrhythmia (7.1%). There were no difference in demography, group of risk (ELN) in ICU and non-ICU pts, but in ICU pts anemia, leukocytosis were more severe. Need for vasopressors and mechanical ventilations were mortality predictors. ICU survival rate was 63.4%. A landmark analysis for overall survival (OS) was performed for patients who survived after life threatening complication in ICU group: 5-year OS - 43.2%, 5-year disease free survival (DFS) - 34%. In non-ICU group 5-yeas OS - 53%, 5-year DSF - 44% (p=0.504). Conclusion. After discharging from ICU the long - term prognosis of ICU-pts is not worse, than non-ICU pts.

About the authors

A V Bazhenov

National Research Center for Hematology

Email: doctorbazhenov@gmail.com
аспирант отд-ния реанимации и интенсивной терапии ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0001-9597-8148 Moscow, Russia

G M Galstyan

National Research Center for Hematology

д.м.н., зав. отд-нием реанимации и интенсивной терапии ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0001-8818-8949 Moscow, Russia

E N Parovichnikova

National Research Center for Hematology

д.м.н., зав. отд. химиотерапии гемобластозов, депрессий кроветворения и трансплантации костного мозга ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0001-6177-3566 Moscow, Russia

V V Troitskaya

National Research Center for Hematology

к.м.н., зав. отд-нием химиотерапии гемобластозов и депрессий кроветворения с круглосуточным стационаром ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0002-4827-8947 Moscow, Russia

L A Kuzmina

National Research Center for Hematology

к.м.н., зав. отд-нием интенсивной высокодозной химиотерапии и трансплантации костного мозга с круглосуточным и дневным стационарами в составе отдела химиотерапии гемобластозов, депрессий кроветворения и трансплантации костного мозга ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0001-6201-6276 Moscow, Russia

Z T Fidarova

National Research Center for Hematology

к.м.н., зав. отд-нием интенсивной высокодозной химиотерапии гематологических заболеваний с круглосуточным и дневным стационарами ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0002-4155-7820 Moscow, Russia

E O Gribanova

National Research Center for Hematology

к.м.н., зав. отд-нием химиотерапии гемобластозов и депрессий кроветворения с дневным стационаром ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0003-0934-6094 Moscow, Russia

S A Makhinya

National Research Center for Hematology

к.м.н., врач-гинеколог ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0001-9923-1711 Moscow, Russia

O A Latyshkevich

Center of Family Planning and Reproduction

к.м.н., врач-акушер-гинеколог, главный врач ГБУЗ «Центр планирования семьи и репродукции» Департамента здравоохранения города Москвы; ORCID: 0000-0002-3467-4236 Moscow, Russia

U A Chabaeva

National Research Center for Hematology

сотрудник информационно-аналитического отд. ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0001-8044-598X Moscow, Russia

S M Kulikov

National Research Center for Hematology

к.т.н., зав. информационно-аналитическим отд. ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0002-6288-7570 Moscow, Russia

V G Savchenko

National Research Center for Hematology

акад. РАН, д.м.н., проф., генеральный директор ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0001-8188-5557 Moscow, Russia

References

  1. Mc Guire S. World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Adv Nutr An Int Rev J. 2016;7(2):418-9. doi: 10.3945/an.116.012211
  2. Dizon D, Krilov L, Cohen E. Clinical Cancer Advances 2016: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. J Clin Oncol. 2016;34(9):987-1011. doi: 10.1200/JCO.2015.65.8427
  3. Garcia-Manero G, Othus M, Pagel J. SWOG S1203: A Randomized Phase III Study of Standard Cytarabine Plus Daunorubicin (7+3) Therapy Versus Idarubicin with High Dose Cytarabine (IA) with or without Vorinostat (IA+V) in Younger Patients with Previously Untreated Acute Myeloid Leukemia (AML). Blood. 2016;128(22). http://www.bloodjournal.org/content/128/22/901?sso-checked=true. Accessed March 6, 2018.
  4. Burnett A, Russell N, Hills R. A randomized comparison of daunorubicin 90 mg/m 2 vs 60 mg/m 2 in AML induction: results from the UK NCRI AML17 trial in 1206 patients. Blood. 2015;125(25):3878-85. doi: 10.1182/blood-2015-01-623447
  5. Döhner H, Estey E, Grimwade D. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129(4):424-47. doi: 10.1182/blood-2016-08-733196
  6. Denardo S, Oye R, Bellamy P. Efficacy of intensive care for bone marrow transplant patients with respiratory failure. Crit Care Med. 1989;17(1):4-6. http://www.ncbi.nlm.nih. gov/pubmed/2642401. Accessed July 13, 2017.
  7. Schuster D. Everything that Should Be Done-Not Everything that Can Be Done. Am Rev Respir Dis. 1992;145(3):508-9. doi: 10.1164/ajrccm/145.3.508
  8. Turnbull A, Carlon G, Baron R, Sichel W, Young C, Howland W. The inverse relationship between cost and survival in the critically ill cancer patient. Crit Care Med. 1979;7(1):20-3. http://www.ncbi.nlm.nih.gov/pubmed/104824. Accessed July 11, 2017.
  9. Crawford S, Petersen F. Long - term Survival from Respiratory Failure after Marrow Transplantation for Malignancy. Am Rev Respir Dis. 1992;145(3):510-4. doi: 10.1164/ajrccm/ 145.3.510
  10. Lloyd-Thomas A, Wright I, Lister A, Hinds C. Prognosis of patients receiving intensive care for lifethreatening medical complications of haematological malignancy. Br Med J (Clin Res Ed). 1988;296(6628):1025-9. http://www.ncbi.nlm.nih.gov/pubmed/3130123. Accessed July 5, 2017.
  11. Tack C, Santman F. Results of intensive care treatment in patients with hematologic malignancies; relation to infections. Ned Tijdschr Geneeskd. 1992;136(1):25-9. http://www.ncbi. nlm.nih.gov/pubmed/1728759. Accessed July 18, 2017.
  12. Lloyd-Thomas A, Dhaliwal H, Lister T, Hinds C. Intensive therapy for life - threatening medical complications of haematological malignancy. Intensive Care Med. 1986;12(4):317-24. http://www.ncbi.nlm.nih.gov/pubmed/3463606. Accessed July 13, 2017.
  13. Brunet F, Lanore J, Dhainaut J. Is intensive care justified for patients with haematological malignancies? Intensive Care Med. 1990;16(5):291-7. http://www.ncbi.nlm.nih.gov/pubmed/ 2212252. Accessed July 5, 2017.
  14. Yau E, Rohatiner A, Lister T, Hinds C. Long term prognosis and quality of life following intensive care for life - threatening complications of haematological malignancy. Br J Cancer. 1991;64(5):938-42. http://www.ncbi.nlm.nih.gov/pubmed/1931620. Accessed July 15, 2017.
  15. Van Vliet M, Verburg I, Van Den Boogaard M. Trends in admission prevalence, illness severity and survival of haematological patients treated in Dutch intensive care units. Intensive Care Med. 2014;40(9):1275-84. doi: 10.1007/s00134-014-3373-x
  16. Abdul-Jabbar S, Bates I, Davies G, Shulman R. An analysis of medicine costs of adult patients on a critical care unit. J Crit Care. 2014;29(3):472.e7-e472.e12. doi: 10.1016/j.jcrc. 2013.12.014
  17. Schuster D, Marion J. Precedents for meaningful recovery during treatment in a medical intensive care unit. Outcome in patients with hematologic malignancy. Am J Med. 1983;75(3):402-8. http://www.ncbi.nlm.nih.gov/pubmed/6577789. Accessed July 13, 2017.
  18. Benoit D, Vandewoude K, Decruyenaere J, Hoste E, Colardyn F. Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life - threatening complication. Crit Care Med. 2003;31(1):104-12. doi: 10.1097/01. CCM.0000038213.27741.30
  19. Moors I, Pène F, Lengline É, Benoit D. Urgent chemotherapy in hematological patients in the ICU. Curr Opin Crit Care. November 2015:1. doi: 10.1097/MCC.0000000000000254
  20. Azoulay E, Pène F, Darmon M, Lengliné E, Benoit D,Soares M. Managing critically Ill hematology patients: Time to think differently. Blood Rev. 2015;29(6):359-67. doi: 10.1016/j.bl re.2015.04.002
  21. Ñamendys-Silva S, González-Herrera M, García-Guillén F, Texcocano-Becerra J, Herrera-Gómez A. Outcome of critically ill patients with hematological malignancies. Ann Hematol. 2013;92(5):699-705. doi: 10.1007/s00277-013-1675-7
  22. Jackson K, Mollee P, Morris K, Butler J, Jackson D, Kruger P, Klein K, Kennedy G. Outcomes and prognostic factors for patients with acute myeloid leukemia admitted to the intensive care unit. Leuk Lymphoma. 2013;55(April):1-8. doi: 10.3109/10428194.2013.796045
  23. Bird G, Farquhar-Smith P, Wigmore T, Potter M, Gruber PC. Outcomes and prognostic factors in patients with haematological malignancy admitted to a specialist cancer intensive care unit: a 5 yr study. Br J Anaesth. 2012;108(3):452-9. doi: 10.1093/bja/aer449
  24. Hinds C, Martin R, Quinton P. Intensive care for patients with medical complications of haematological malignancy: is it worth it? Schweiz Med Wochenschr. 1998;128(39):1467-73. http://www.ncbi.nlm.nih.gov/pubmed/9793166. Accessed October 10, 2017.
  25. Massion P, Dive A, Doyen C. Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med. 2002;30(10):2260-70. doi: 10.1097/01.CCM.000 0030456.11264.EF
  26. Ahmed T, Koch A, Isom S. Outcomes and changes in code status of patients with acute myeloid leukemia undergoing induction chemotherapy who were transferred to the intensive care unit. Leuk Res. 2017;62:51-5. doi: 10.1016/j.leukres.2017.09.017
  27. Roze des Ordons L, Chan K, Mirza I, Townsend D, Bagshaw S. Clinical characteristics and outcomes of patients with acute myelogenous leukemia admitted to intensive care: a case - control study. BMC Cancer. 2010;10:516. doi: 10.1186/1471-2407-10-516
  28. Schellongowski P, Staudinger T, Kundi M. Prognostic factors for intensive care unit admission, intensive care outcome, and post - intensive care survival in patients with de novo acute myeloid leukemia: a single center experience. Haematologica. 2011;96(2). http://www. haematologica.org/content/96/2/231. Accessed July 19, 2017.
  29. Савченко В.Г., Паровичникова Е.Н., Афанасьев Б.В. Национальные клинические рекомендации по диагностике и лечению острых миелоидных лейкозов взрослых. Гематология и трансфузиология. 2014;59(2):3-28.
  30. Singer M, Deutschman C, Seymour C. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10. doi: 10.1001/jama.2016.0287
  31. Fan E, Brodie D, Slutsky A.S. Acute Respiratory Distress Syndrome. JAMA. 2018;319(7): 698. doi: 10.1001/jama.2017.21907
  32. Morelli A, Ertmer C, Rehberg S, et al. Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): A randomized, controlled pilot study. Crit Care. 2009;13(4):1-14. doi: 10.1186/cc7990
  33. Савченко В.Г., Паровичникова Е.Н., Троицкая В.В., Махиня С.А., Галстян Г.М., Латышкевич О.А. Протокол лечения острых лейкозов на фоне беременности. In: Алгоритмы диагностики и протоколы лечения заболеваний системы крови. М., 2018:753-792.
  34. Hartsock B, Lim M, Roth C, Raptis N, Weber D, Sehgal A, Boyiadzis M, Raptis A, Hou J,Im A, Dorritie K, Marks S, Agha M, Lim S. ICU intervention during induction chemotherapy for adult patients with newly diagnosed acute myeloid leukemia. Leuk Res. 2016;48:16-9. doi: 10.1016/j.leukres.2016.07.001
  35. Simonazzi G, Bisulli M, Saccone G, Moro E, Marshall A, Berghella V. Tranexamic acid for preventing postpartum blood loss after cesarean delivery: A systematic review and meta - analysis of randomized controlled trials. Acta Obstet Gynecol Scand. 2016;95(1):28-37. doi: 10.1111/aogs.12798
  36. Sippel C, Kim Y, Wallau A, Brossart P, Schmidt-Wolf I, Walger P. AML versus ICU: outcome of septic AML patients in an intensive care setting. J Cancer Res Clin Oncol. 2015;141(9):1645-51. doi: 10.1007/s00432-015-1955-9
  37. Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne L, Rabbat A, Lebert C, Perez P, Chaize M, Renault A, Meert A, Benoit D, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V. Outcomes of Critically Ill Patients With Hematologic Malignancies: Prospective Multicenter Data From France and Belgium-A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study. J Clin Oncol. 2013;31(22):2810-8. doi: 10.1200/JCO.2012.47.2365
  38. Othus M, Kantarjian H, Petersdorf S, Ravandi F, Godwin J, Cortes J, Pierce S, Erba H, Faderl S, Appelbaum F, Estey E. Declining rates of treatment - related mortality in patients with newly diagnosed AML given “intense” induction regimens: a report from SWOG and MD Anderson. Leukemia. 2014;28(2):289-92. doi: 10.1038/leu.2013.176
  39. Estey E, Smith T.L, Keating M.J, Mc Credie K.B, Gehan E.A, Freireich E.J. Prediction of survival during induction therapy in patients with newly diagnosed acute myeloblastic leukemia. Leukemia. 1989;3(4):257-63. https://www.scopus.com/record/display.uri?eid=2-s2.0-0024510651& origin=inward&txGid=d755ba4b8a78e0cd3abff771339a1447. Accessed November 30, 2017.
  40. Walter R.B, Othus M, Borthakur G, Ravandi F, Cortes J, Pierce S, Appelbaum F, Kantarjian H, Estey E. Prediction of Early Death After Induction Therapy for Newly Diagnosed Acute Myeloid Leukemia With Pretreatment Risk Scores: A Novel Paradigm for Treatment Assignment. J Clin Oncol. 2011;29(33):4417-24. doi: 10.1200/JCO.2011.35.7525
  41. Yeo C, Kim J, Kim S, Kim Y, Kim K, Kim H, Lee F, Rhee C. Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive care unit. J Crit Care. 2012;27(6):739.e1-e739.e6. doi: 10.1016/j.jcrc.2012.07.014
  42. Price K.J, Cardenas-Turanzas M, Lin H, Roden L, Nigam R, Nates J.L. Prognostic indicators of mortality of mechanically ventilated patients with acute leukemia in a comprehensive cancer center. Minerva Anestesiol. 2012;79(2):147-55.
  43. Evison J.M, Rickenbacher P, Ritz R, Gratwohl A, Haberthür C, Elsasser S, Passweg J. Intensive care unit admission in patients with haematological disease: Incidence, outcome and prognostic factors. Swiss Med Wkly. 2001;131:681-6.
  44. Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le R, Fermand P, Schlemmer B. Changing use of intensive care for hematological patients: The example of multiple myeloma. Intensive Care Med. 1999;25(12):1395-401. doi: 10.1007/s001340051087
  45. Depuydt P, Benoit D, Vandewoude K, Decruyenaere J, Colardyn F. Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest. 2004;126(4):1299-306. doi: 10.1378/chest.126.4.1299
  46. Rabbat A, Chaoui D, Montani D, Legrand O, Lefebvre A, Rio B, Roche N, Lorut C, Marie J, Huchon G. Prognosis of patients with acute myeloid leukaemia admitted to intensive care. Br J Haematol. 2005;129(3):350-7. doi: 10.1111/j.1365-2141.2005.05459.x
  47. Pohlen M, Thoennissen N, Braess J, Thudium J, Schmid C, Kochanek M, Kreuzer K, Lebiedz P, Görlich P, Gerth H, Rohde C, Kessler C, Müller-Tidow C, Stelljes M, Büchner T, Schlimok G, Hallek M, Waltenberger J, Hiddemann W, Berdel W, Heilmeier B, Krug U. Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction. PLoS One. 2016;11(8):e0160871. doi: 10.1371/journal.pone.0160871
  48. Larché J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G, Darmon M, Le G, Schlemmer B. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med. 2003;29(10):1688-95. doi: 10.1007/s00134-003-1957-y
  49. Silfvast T, Pettila V, Ihalainen A, Elonen E. Multiple organ failure and outcome of critically ill patients with haematological malignancy. Acta Anaesthesiol Scand. 2003;47:301-6. https://doi.org/10.1034/j.1399-6576.2003.00058.x
  50. Kroschinsky F, Weise M, Illmer T, Haenel M, Bornhaeuser M, Hoeffken G, Ehninger G, Schuler U. Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies. Intensive Care Med. 2002;28(9):1294-300. doi: 10.1007/s00134-002-1420-5
  51. Hampshire P.A, Welch C.A, Mc Crossan L.A, Francis K, Harrison D.A. Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: A secondary analysis of the ICNARC Case Mix Programme Database. Crit Care. 2009;13(4):R137. doi: 10.1186/cc8016
  52. Lamia B, Hellot M.F, Girault C, Lamia, B. Hellot M, Girault C, Tamion F, Dachraoui F, Lenain P, Bonmarchand G. Changes in severity and organ failure scores as prognostic factors in onco - hematological malignancy patients admitted to the ICU. Intensive Care Med. 2006;32(10):1560-8. doi: 10.1007/s00134-006-0286-3
  53. Guven G.S, Uzun O, Cakir B, Akova M, Unal S. Infectious complications in patients with hematological malignancies consulted by the Infectious Diseases team: A retrospective cohort study (1997-2001). Support Care Cancer. 2006;14(1):52-5. doi: 10.1007/s00520-005-0836-1
  54. Сёмочкин С.В., Толстых Т.Н., Архипова Н.В., Иванова В.Л., Клюева О.В., Лунин В.В., Мисюрина Е.Н., Туманова М.В., Хуажева Н.К. Клинико - эпидемиологическая характеристика острых миелоидных лейкозов у взрослых по данным муниципальных отделений гематологии Москвы. Терапевтический архив. 2015;87(7):26-32. doi: 10.17116/terarkh201587726-32
  55. Воробьев А.И., Горелов В.Г., Городецкий В.М., Шулутко Е.М. Критические состояния при гемобластозах (типичные формы и выживаемость в условиях отделения реанимации). Терапевтический архив. 1993;65(7):3-6.
  56. Галстян Г.М., Городецкий В.М. Опыт работы отделения реанимации и интенсивной терапии ФГБУ ГНЦ МЗиСР РФ. Клиническая онкогематология. 2011;4(1):75-8.
  57. Grgić Medić M, Gornik I, Gašparović V. Hematologic malignancies in the medical intensive care unit - Outcomes and prognostic factors. Hematology. 2014;(5):247-53. doi: 10.1179/1607845414Y.0000000206

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