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Intensive care essential for patients with acute myeloid leukaemia

(Vienna, 18th February 2011) In patients with acute myeloid leukaemia the mortality rate in the early phase of detection is particularly high if additional complications occur, even if these patients receive intensive medical care. A current study at the MedUni Vienna shows that through a sophisticated approach, surprisingly good results for affected patients can be achieved.

In one in seven patients with acute myeloid leukaemia (AML) complications such as e.g. respiratory failure or haemorrhages occur at the beginning of intensive chemotherapy. Through sophisticated intensive care in recent years the mortality rate has been able to be reduced from almost one hundred percent depending on the severity of the complication down to below fifty percent. During a retrospective study by MedUni Vienna, with almost 400 patients, Dr. Peter Schellongowski in a team with Associate Professor. Dr. Wolfgang R. Sperr (University Department of Internal Medicine I), analysed the risk and prognosis factors.

According to this analysis patients with additional underlying illnesses, infections or a low fibrinogen level have a particularly high risk of complications. However, it was surprising that the survival chance of AML patients during the acute phase (within 30 days) under intensive care is only affected by the severity of the complication. The classic risk factors of AML have no effect in practical terms during this phase. Furthermore, with regard to long-term prognosis (6 years) no differences could be determined between patients without complications and survivors of the acute phase following intensive care.

During this study, the progress of disease of a total of 406 patients with “de novo” AML (diagnosed for the first time) between the ages of 15 and 89 were examined. During this the markers for the karyotype, fibrinogen level, the C-reactive protein and the Charlson Comorbidity Index amongst others were included. In patients with subsequent intensive care the internationally common SAPS II (Simplified Acute Physiology Score II: prognosis value for the chance of survival), the need for artificial ventilation and the use of medications to support blood pressure were also taken into consideration. Multivariate data analysis procedures were used for the weighting of these individual parameters with regard to their prognostic relevance.

„The study results should help break down some of the resentment that occurs when these patients are admitted to an intensive care ward,” commented Schellongowski with regard to the results and he also stated: “Intensive medical support should absolutely be available during the initial phase of the disease.“

The study was published in the current edition of the renowned haematology journal “Haematologica”:
» Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in de novo acute myeloid leukemia: a single center experience.
Schellongowski P, Staudinger T, Kundi M, Laczika K, Locker GJ, Bojic A, Robak O, Fuhrmann V, Jäger U, Valent P, and Sperr WR.
Haematologica 2011;96(2):231-237. doi:10.3324/haematol.2010.031583