Pulmonary complications of leukemia.

T he leukemias are a diverse group ofdisorders. The natural history and management of the acute and chronic leukemias are distinctly different. Several different pulmonary complications are common in patients with any ofthe leukemias. These are dependent upon multiple factors, including the type of leukemia, the nature and time course of treatment, and the presence or absence ofsignificant neutropenia or thrombocytopenia. Tenholder and Hooper’ found that 98 percent of leukemic patients who came to autopsy had pulmonary complications. The true mcidence of pulmonary complications in leukemia is difficult to assess because most series reported are selected for patients with specific pulmonary problems or particular leukemias. Moreover, the incidence varies over a wide range, depending upon whether symptoms, chest radiographs, pulmonary function tests, or autopsy findings alone are used as the index of disease. Pulmonary conditions that must be considered in the differential diagnosis of the immunocompromised host, such as the patient with leukemia, are listed in Table 1.2,3 Many of the pulmonary abnormalities are not due to the leukemia itself, but are caused by the patient’s immunocompromised status, medications, or a complicating medical illness. All of the conditions listed in Table 1 should be considered during evalualion ofthese patients in order to narrow the differential diagnosis as much as possible and to avoid unnecessary invasive diagnostic procedures. In Tenholder and Hooper’s’ review of the records of 139 patients with leukemia at the Walter Reed Army Medical Genter to determine the etiology of associated pulmonary infiltrates, in 84 instances of parenchymal infiltrates for which a cause was found, only 10 were attributed conclusively to leukemic cell infiltration of Habermann, M.D.;t