Evaluating Pulmonary Complications in Childhood Acute Leukemias

OBJECTIVES: Pulmonary complications are frequently encountered in childhood acuteleukemias. The prognosis remains poor in spite of the recent improvements in antimicrobialand supportive therapies. The purpose of this study was making contribution to reduce themortality and morbidity owing to the pulmonary complications by identifying the propertiesof them in childhood acute leukemias.PATIENTS AND METHODS: All patients who had been treated in Dokuz Eylül UniversityDepartment of Pediatric Hematology and who developed pulmonary complications betweenNovember 1989 and Augst 2005 were included in the study. Clinical, laboratory, radiologicfeatures of the patients were evaluated as well as the properties of the acute leukemia.Properties associated with the diagnosis, treatment, clinical course and outcome wereinvestigated.RESULTS: In the study 79 pulmonary complications were observed in 66 patients (42 male,24 female) with the average age of 7.49 ± 5.2 (1-17). Pulmonary complications developedmostly in the consolidation phase of the therapy and 92.4% of these complications hadinfectious aetiology. In neutropenic period 31.6% of the pulmonary complications developed.Normal physical examination and radiologic findings were found 7.6% and 13.9%respectively in neutropenic patients. Tachypnea, clinical manifestations of shock, requirementof oxygen and mechanical ventilation, disseminated intravascular coagulation, involvement ofother organs or systems, neutropenia, anemia, thrombocytopenia and requirement ofmodification in antimicrobial drugs were found in association with mortality. Pulmonarycomplications in neutropenic periods were mostly seen in the induction and consolidationphase of the chemotherapy. Factors associated with high mortality were more frequentlydetermined in this group of patients. Patients who developed pulmonary complications in themaintainance phase had bone marrow supression less frequently. Most of them could besuccessfully treated with short courses of oral antibiotics.CONCLUSION: In children with acute leukemia and pulmonary complications, pulmonaryinfections priorly must be taken in consideration at the stage of planning diagnostic processesand treatment. Respiratory symptoms, findings of physical examination and chest radiographymust be evaluated carefully. For patients who develop pulmonary infections in the inductionand the consolidation phase of the chemotherapy and in the neutropenic period, rapid andagressive treatment modalities are obligatory to reduce the mortality.Key words: Pulmonary complications, childhood, acute leukemia