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Journal of Clinical Oncology, Vol 23, No 6 (February 20), 2005: pp. 1327 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.05.182
Prognosis of Acute Monocytic Leukemia (French-American-British Classification M5)Medical Intensive Care Unit, Saint Louis University Hospital, Paris, France To the Editor: We have read with interest the manuscript from Tallman et al.1 Overall, the information provided on the lack of prognostic signification of the acute monocytic leukemia (AML) M5 subtype, although based on subgroup analysis from small number of patients included into three prospective studies, is important and clinically relevant in our daily practice. Moreover, the fact that two of the three studies reported were restricted to the younger patients might have introduced selection bias.2,3 However, when discussing the subtype of AML, specific consideration are in order. As intensivists regularly managing patients with AML, we believe that information on the AML subtype is mandatory, particularly in patients with AML M5. Indeed, we have recently reported that AML presented frequently with hyperleukocytosis, acute tumor lysis syndrome, or acute respiratory failure.4 This explains why approximately 20% of AML M5 patients need intensive care admission for leukemic pulmonary infiltration and renal and cardiovascular failure.4 In our experience, these patients need chemotherapy induction in the intensive care unit, along with noninvasive mechanical ventilation, dialysis, and sometimes vasoactive agents, and only half of them survive. In keeping with the article from Tallman et al, we believe that provided their severity, these patients are not included in the studies reported in reference, therefore providing an additional source of bias. Additional studies should confirm the results from Tallman et al in a nonselected patient population with AML. In the meantime, patients with AML M5 should receive careful clinical evaluation and early intensive care unit admission to afford a higher chance of recovery using noninvasive diagnostic and therapeutic strategies.5,6 Authors' Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest. REFERENCES
1. Tallman MS, Kim HT, Paietta E, et al: Eastern Cooperative Oncology Group: Acute monocytic leukemia (French-American-British classification M5) does not have a worse prognosis than other subtypes of acute myeloid leukemia—A report from the Eastern Cooperative Oncology Group. J Clin Oncol 22:1276-1286, 2004
2. Rowe JM, Neuberg D, Friedenberg W, et al: Eastern Cooperative Oncology Group: A phase 3 study of three induction regimens and of priming with GM-CSF in older adults with acute myeloid leukemia—A trial by the Eastern Cooperative Oncology Group. Blood 103:479-485, 2004
3. Cassileth PA, Harrington DP, Appelbaum FR, et al: Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission. N Engl J Med 339:1649-1656, 1998
4. Azoulay E, Fieux F, Moreau D, et al: Acute monocytic leukemia presenting as acute respiratory failure. Am J Respir Crit Care Med 167:1329-1333, 2003 5. Hilbert G, Gruson D, Vargas F, et al: Bronchoscopy with bronchoalveolar lavage via the laryngeal mask airway in high-risk hypoxemic immunosuppressed patients. Crit Care Med 29:249-255, 2001[CrossRef][Medline] 6. Azoulay E, Alberti C, Bornstain C, et al: Improved survival in cancer patients requiring mechanical ventilatory support: Impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519-525, 2001[CrossRef][Medline]
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Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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