Pulmonary Complications Caused by Acute Leukemia

REVIEW ARTICLE

Kazuhiko Kakihana, Kazuteru Ohashi and Hideki Akiyama

Affiliation: Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

ABSTRACT

Infectious and noninfectious pulmonary complications represent a critical problem for patients with leukemia, which itself can be the direct cause of pulmonary leukostasis, pulmonary leukemic infiltration (PLI), and leukemic cell lysis pneumopathy. These disorders are usually more frequent in patients with hyperleukocytic leukemia. Pulmonary leukostasis is characterized by occlusion of the pulmonary capillaries and arterioles by leukemic cells. Neurological signs can also simultaneously arise if the central nervous system is affected. The number of circulating leukemic cells as well as interactions between leukemic and epithelial cells play important roles in the progression of leukostasis. Although PLI is the most common form of pulmonary involvement, antemortem diagnosis is very difficult. High resolution computed tomography is a useful, noninvasive tool that can identify PLI as abnormal shadows distributed along the bronchovascular bundle. Transbronchoscopic biopsy can help to correctly diagnose patients who undergo stem cell transplantation, as graft versus host disease renders such diagnosis far more difficult. Leukemic cell lysis pneumopathy is characterized by acute respiratory failure relatively early during the course of chemotherapy. Some enzymatic proteins released by degenerate leukemic cells might be potential agents involved in the development of pneumopathy. This report reviews the clinical manifestations of pulmonary complications associated with leukemia.

Keywords: pulmonary leukostasis, pulmonary leukemic infiltration, leukemic cell lysis pneumopathy, hyperleukocytosis

Correspondence: Kazuhiko Kakihana, Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. Tel: +81 3823 2101; Fax: +81 3 3824 1552; e-mail: kakihana@cick.jp