The MDS Beacon™

Acute pulmonary failure is a rare but serious complication of chemotherapy.  The condition is characterized by lung injury and respiratory distress, and it is unrelated to heart failure.

MDS patients receive chemotherapy drugs to kill cancerous cells, help bone marrow to produce healthy blood cells, and prepare for bone marrow transplantation.  Intensive treatments usually range from six to nine months, and bring short-term reduction of symptoms for as high as 60 percent of MDS patients.

Researchers reviewed 1541 newly diagnosed AML and High-risk MDS patients undergoing intensive chemotherapy.  High-risk MDS patients had greater than 10 percent blasts, which are mass groupings of cells. AML patients showed greater than 20 percent blasts.

Patients requiring mechanical ventilatory support in the intensive care unit within two weeks of the initiation of chemotherapy regimen were categorized as having acute pulmonary failure.

The study did not distinguish AML from MDS patients.  Results showed that 8 percent developed acute pulmonary failure, 30 percent did not respond to treatment, and 14 percent died within six weeks of beginning chemotherapy.  These effects were similar for AML and High-risk MDS patients.

Fifty-five percent achieved complete response, as defined by the 2000 International Working Group criteria as having a blood count of more than 1,000 neutrophil per mL (type of white blood cell) and more than 100,000 platelets per mL (growth cells).

The median duration of complete response for all patients after starting chemotherapy was eight months.  Patients who developed acute pulmonary failure survived a median of three weeks, while those who did not experience lung failure survived for a median of 15 months.

There are no definite factors for predicting acute pulmonary failure; course and prognosis of the condition are not well understood.  In addition, it is often difficult to discern the most important cause when there are multiple contributing factors.

This study revealed pre-existing conditions that may predispose AML and High-risk MDS patients for lung failure.  These include being male, having acute promyelocytic leukemia, not responding well to chemotherapy, and the presence of lung infiltrate at diagnosis.

Although the causes of acute pulmonary failure cannot be identified and prevented completely, MDS patients can be monitored for signs of predisposing factors.  The authors suggest supportive care is important, such as platelet support for High-risk patients, restriction of fluids, and other methods to reduce the probability of unnecessary bleeding.

Such strategies can increase the tolerance of high-intensity chemotherapy and ultimately increase long-term outcomes of High-risk MDS patients.

For more information, please see the journal Cancer (abstract).