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

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.