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Dexamethasone may help injured lungs in monocytic leukemia

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Dexamethasone may be a useful supplement to standard treatment of certain patients with acute monocytic leukemia, French researchers report in an August 4th on-line paper in the European Respiratory Journal.

Dr. Elie Azoulay told Reuters Health by email “compared to historical controls, patients given dexamethasone in addition to conventional chemotherapy had significantly lower ICU and hospital mortality rates. The rate of respiratory status deterioration after chemotherapy initiation was nonsignificantly lower with dexamethasone.”

Dr. Azoulay of Hopital Saint-Louis, Paris and colleagues note that the use of steroids is not required in myeloid malignancies and remains controversial. But, he added, “Acute monocytic leukemia can manifest as acute lung injury or acute respiratory distress due to lung involvement by the malignancy before chemotherapy initiation.”

To gain more information on use of dexamethasone, the team the looked at data from 20 patients who had received the steroid along with chemotherapy between 2005 and 2008. These were compared with data from 20 controls treated between 1994 and 2002.

There were 4 deaths in the ICU and the dexamethasone group had a significantly lower ICU mortality rate (20% versus 50%). There were no further deaths during hospitalization. The dexamethasone group also showed a trend towards less respiratory deterioration (50% versus 80%).

Chemotherapy initiation was followed by respiratory status deterioration in only 4 (20%) dexamethasone-treated patients compared to all of the 20 controls.

In addition, dexamethasone therapy was not associated with increased rates of hospital-acquired bacterial or invasive fungal infections.

Mortality can be high in these patients, continued Dr. Azoulay, “Steroids may control leukemia cells burden and then avoid respiratory deterioration from cancer chemotherapy.”

Given these findings, the researchers call for a placebo controlled trial in patients with non-infectious pulmonary infiltrates.

Dexamethasone in Patients with Acute Lung Injury from Acute Monocytic Leukemia
Eur Respir J 2011.