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Desprez C, Kouatchet A, Marchand T, Mear JB, Tadié JM, Peterlin P, Chevalier P, Canet E, Couturier MA, Guillerm G, Bodenes L, Gyan E, Villate A, Ehrmann S, Lebreton A, Lester MA, Fronteau C, Larhantec G, André V, Riou J, Hunault-Berger M, Schmidt-Tanguy A, Orvain C. Outcome of patients with newly diagnosed AML admitted to the ICU, including preemptive admission - a multi-center study. Ann Hematol 2023; 102:1383-1393. [PMID: 37039874 DOI: 10.1007/s00277-023-05205-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
Acute myeloid leukemia (AML) can lead to life-threatening complications that may require intensive care unit (ICU) management. It has been advocated that early preemptive (ePE) ICU admission, before the onset of organ failure, could benefit some high-risk patients such as those with hyperleukocytosis. The aim of this study was to retrospectively analyze the outcome of newly diagnosed AML patients who required ICU admission in five academic centers with a special focus on patients with an ePE admission strategy, i.e., those transferred to the ICU without any organ failure (modified SOFA score ≤ 2 [omitting thrombocytopenia] and no life-sustaining intervention in the first 24 h following ICU admission) before the start of induction therapy. Between January 2017 and December 2019, 428 patients were included among which 101 were admitted to the ICU. Among patients requiring life-sustaining interventions (n = 83), 18 (22%) died while in the ICU but ICU survivors had the same survival as those not admitted to the ICU. Patients with an ePE admission (n = 18) had more comorbidities and high-risk disease features such as hyperleukocytosis but required no life-sustaining interventions while in the ICU. In a subgroup analysis of patients with hyperleukocytosis ≥ 50 G/l at diagnosis (n = 85), patients not admitted to the ICU and those admitted with an ePE strategy had similar outcomes. This study provides encouraging results about ICU outcome in AML patients during induction therapy but the potential benefit of an ePE strategy must be confirmed prospectively.
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Affiliation(s)
- Christophe Desprez
- Service des maladies du sang, CHU d'Angers, 4 rue LarreyAngers Cedex 9, F-49933, Angers, France
- Service de médecine intensive et réanimation et de médecine hyperbare, CHU d'Angers, Angers, France
| | - Achille Kouatchet
- Service de médecine intensive et réanimation et de médecine hyperbare, CHU d'Angers, Angers, France
| | - Tony Marchand
- Service d'hématologie clinique, CHU de Rennes, Rennes, France
- INSERM U1236, Université Rennes 1, Rennes, France
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
| | | | - Jean Marc Tadié
- Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France
| | - Pierre Peterlin
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'hématologie clinique, CHU de Nantes, Nantes, France
| | - Patrice Chevalier
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'hématologie clinique, CHU de Nantes, Nantes, France
| | | | - Marie-Anne Couturier
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Gaelle Guillerm
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Laetitia Bodenes
- Médecine Intensive et Réanimation, CHU de Brest, Hôpital de la Cavale Blanche, Brest, France
| | - Emmanuel Gyan
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'Hématologie et Thérapie Cellulaire, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - Alban Villate
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Service d'Hématologie et Thérapie Cellulaire, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - Stephan Ehrmann
- Service de Médecine Intensive et Réanimation, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | | | | | | | - Gaelle Larhantec
- Pharmacie Oncologique, CHU de Brest, Hôpital Morvan, Brest, France
| | | | - Jérémie Riou
- Inserm, CNRS, MINT, SFR ICAT, Univ Angers, CHU Angers, Angers, France
| | - Mathilde Hunault-Berger
- Service des maladies du sang, CHU d'Angers, 4 rue LarreyAngers Cedex 9, F-49933, Angers, France
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Université d'Angers, F-49000, Angers, France
| | - Aline Schmidt-Tanguy
- Service des maladies du sang, CHU d'Angers, 4 rue LarreyAngers Cedex 9, F-49933, Angers, France
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Université d'Angers, F-49000, Angers, France
| | - Corentin Orvain
- Service des maladies du sang, CHU d'Angers, 4 rue LarreyAngers Cedex 9, F-49933, Angers, France.
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France.
- Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Université d'Angers, F-49000, Angers, France.
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