12th Congress of the European Hematology ... - Haematologica

normal human BM B progenitor cells and in pre-B ALL cell lines. The
expression of TIEG1 mRNA is regulated by TGF-β and BMP6, and the
role of TIEG1 in mediating the inhibition of proliferation in B progenitor
cells is currently being studied.
0987
EVALUATING PULMONARY COMPLICATIONS IN ACUTE CHILDHOOD LEUKEMIA
S. Yilmaz, B. Erdur, F. Demircioglu, H. Oren, G. Irken
Dokuz Eylul University, IZMIR, Turkey
Background. Pulmonary complications are frequently encountered in
childhood acute leukemias and infectious complications constitute the
leading etiology. Aims. The purpose of this study was to evaluate the frequency,
etiologic factors, and the comorbid conditions affecting the morbidity
and mortality of pulmonary complications in acute childhood
leukemia. Methods. All patients who had been treated in Dokuz Eylül
University Department of Pediatric Hematology and who developed
pulmonary complications at the time of diagnosis, during and after the
treatment between November 1989 and August 2005 were included in
this retrospective study. Patients were treated by the BFM protocols.
Clinical, laboratory, and radiologic features were evaluated as well as the
properties of the acute leukemia. Properties associated with the diagnosis,
treatment, clinical course, and outcome were investigated. Results. A
total of 163 pediatric acute leukemia patients were included in the study.
Sixty-six (40.4%) of them developed a total of 79 pulmonary complications.
The median age was 6 years (range 1-17). Seventy (88.6%) of the
pulmonary complications were observed in ALL and 9 (11.4%) in AML
patients. They mostly developed in the consolidation phase of therapy.
Of these pulmonary complications, 92.4% had infectious etiology. Noninfectious
causes were ARDS in 3, leukostasis in 2, lenfomatoid granulomatosis
in 1, GVHD in 1, pneumothorax in 1, pulmonary edema due
to capillary leak syndrome in 1, and bronchial hyperreactivity in 1
patient. Twenty-five patients (31.6%) were neutropenic during the pulmonary
complication. In 14 (17%) complications microbiological confirmation
of the infectious agent could be successed. The most identified
agent was Klebsiella pneumonia, followed by Aspergillus flavus and
Escherichia coli. Seven (%8.9) patients died because of pulmonary complications,
all were neutropenic and 3 of them weren’t in remission.
Tachypnea, clinical manifestations of shock, requirement of oxygen and
mechanical ventilation, disseminated intravascular coagulation, involvement
of other organs or systems, neutropenia, anemia, thrombocytopenia,
and requirement of modification in antimicrobial drugs were found
in association with increased mortality risk (p2 g/dL rise in Hb concentration after
a median of 8 weeks. One patient responded at week 11, but in this patient
treatment had been discontinued for 3 weeks (from 6th to 8th week)
because of CMV reactivation. Two patients showed CMV reactivation at
the 5th and 6th week of therapy and were treated with oral ganciclovir
for 14 and 21 days respectively. The therapy was well tolerated, with mild
(grade I) haematological and extra-haematological side effects. No episode
of febrile neutropenia or bacterial/fungal infection occurred during the
treatment. The median total dose of alemtuzumab required to obtain the
AIHA response was 220 mg. The median duration of the response was 10
months and only one patient experienced a new episode of AIHA after 26
haematologica/the hematology journal | 2007; 92(s1) | 367