Dexamethasone in Patients with Acute Lung Injury from Acute Monocytic Leukemia

Abstract

The use of steroids is not required in myeloid malignancies and remains controversial in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). We sought to evaluate dexamethasone in patients with ALI/ARDS caused by acute monocytic leukemia (AMLFAB-M5) via either leukostasis or leukemic infiltration. Dexamethasone (10 mg/6 hours until neutropenia) was added to chemotherapy and ICU management in 20 consecutive patients between 2005 and 2008, whose data were compared to those from 20 historical controls (1994–2002). ICU mortality was the primary criterion. We also compared respiratory deterioration rates, need for ventilation, and nosocomial infections. Seventeen (85%) patients had hyperleukocytosis, 19 (95%) had leukemic masses, and all 20 had severe pancytopenia. All patients presented with respiratory symptoms and pulmonary infiltrates prior to AMLFAB-M5 diagnosis. Compared to historical controls, dexamethasone-treated patients had a significantly lower ICU mortality rate (20% vs. 50%, P=0.04) and a trend for less respiratory deterioration (50% vs. 80%, P=0.07). There were no significant increases in the rates infections with dexamethasone. In conclusion, patients with ALI/ARDS related to AML FAB-M5, adding dexamethasone to conventional chemotherapy seemed effective and safe. These results warrant a controlled trial of dexamethasone versus placebo in AMLFAB-M5 patients with non-infectious pulmonary infiltrates.