Acute respiratory failure in adult patients with acute myeloid leukemia

Introduction: Patients with acute myeloid leukemia (AML) are at high risk of developing life-threatening complications. It is estimated that a quarter of adult patients diagnosed with AML will require admission to the intensive care unit (ICU) at least once during their disease. Acute respiratory failure (ARF) is the main reason for ICU admission and is associated with high mortality rates, depending on the etiology of ARF.

Areas covered: In this population, the high prevalence of severe pulmonary infections highlights the importance of immunosuppression caused by the disease and its treatment. In the early stages of the disease, in addition to pneumonia, which should be systematically sought, leukemia-specific lung involvement (leukostasis, leukemic pulmonary infiltration, and acute lysis pneumopathy) is an important cause of ARF in this population, representing up to 60% of cases. This review aims to help understand the pathophysiology and management of leukemia-specific lung involvement, based on the most contemporary literature.

Expert opinion: The number of AML patients requiring ICU care is expected to increase. AML patients admitted to the ICU for ARF have a high mortality rate, but survivors have encouraging long-term outcomes. Future research will focus on improving risk stratification, cytoreduction, oxygenation strategies, and diagnostic techniques for ARF.