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INTENSIVE CARE OF THE LIFE -THREATING COMPLICATION DE NOVO ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) PATIENTS (PTS)

PF186

Bazhenov, A.1; Galstyan, G.1; Parovichnikova, E.2; Troitskaya, V.2

doi: 10.1097/01.HS9.0000558960.08216.39
Poster Session I: Acute lymphoblastic leukemia - Clinical
Free

1ICU

2Hematology, National Research Center ffor Hematology, Moscow, Russian Federation

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Background:

Treatment of ALL pts can be associated with the life-threating complications requiring intensive care unit (ICU) admission. The long-term outcomes of ALL pts after discharge from ICU is unknown.

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Aims:

To compare the overall survival (OS) of de novo ALL pts who required and not required ICU admission during induction remission chemotherapy.

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Methods:

All de novo ALL pts (median age 28 yo, 17-60 yo), treated from 2013 to 2017, were enrolled into the study. Pts were divided into 2 groups: pts required ICU admission (ICU group), and pts not required ICU admission (non-ICU group). Landmark OS was assessed by the Kaplan - Meier method, log rank value p < 0.05 was considered as significant. Landmark was the date of discharge from ICU, and median time of discharge from ICU. Univariate analysis was performed with χ 2 tests or Fisher's exact tests for categorical variables to find an independent ICU mortality predictor.

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Results:

In total, 87 ALL pts were enrolled into the study, 18 (20.6%) of them pts required ICU admission and 69 pts were treated without ICU. Reasons for ICU admissions were: acute respiratory failure (44%), acute neurological events (28%), tumor lysis syndrome (17%), septic shock (SS) (11%). Mechanical ventilation (MV) was required in 28% of pts, vasopressor support - in 28% of pts, and renal replacement therapy - in 22% of pts. ICU survival rate was 89% (2 pts died in ICU due to the SS). Needs for MV and for vasopressors were independent predictors of ICU mortality (p < 0.05). No one pts died in non-ICU group during induction chemotherapy. Five year OS was 44% and 76% in ICU and non-ICU group, respectively, (p < 0.05) (figure 1).

Figure

Figure

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Summary/Conclusion:

Despite high ICU survival rate (89%), 5- years OS was only 44%. I non-ICU group OS was 76% (p < 0.05). The long-term prognosis of ALL pts discharged from ICU worse in comparison AML pts discharged from ICU [1,2]. This phenomenon it could be explained by negative selection of ALL pts in ICU.

Reference

1. The influence of ICU admission of the patients with de novo AML on the long-term survival. Bazhenov A., Galstyan G., Parovichnikova E. et al. Intensive care medicine experimental. 2018 (6) supplement 2. P.4422. 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. Schellongowski P. Haematologica. 2011. Nº 2 (96).

Copyright © 2019 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.