Features of pneumonia in patients with hemoblastosis in the Amur Region

Aim. To study the features of the etiology and clinical course of pneumonia in patients with hemoblastoses who underwent programmed chemotherapy.

Materials and methods. Case histories and outpatient records of patients with hemoblastoses who were treated in the hematology department of the Amur Regional Clinical Hospital in 2012-2018 were studied, in whom pneumonia was added during programmed chemotherapy: 54 patients with acute leukemia (AL), of which 24 patients with acute lymphoblastic (ALL) and 30 patients with acute myeloid (AML) leukemia; 75 patients with chronic lymphocytic leukemia (CLL) in stages B and C according to the Binet Classification; 43 patients with multiple myeloma (MM). The control group included 30 patients with nosocomial pneumonia without hemoblastosis who were treated in the pulmonology department of Amur Regional Clinical Hospital.

Results. Pneumonia is the most common infectious complication of CLL (39%) and MM (35%). The most common infectious complications of AL during programmed chemotherapy are febrile neutropenia - 30%, mucositis - 30%, pneumonia account for 18% of all infectious complications of acute lymphoblastic and 21% of myeloid leukemia. In patients with AL, gram-positive pneumonia pathogens predominate. In patients with CLL and MM, gram-negative flora predominates. Most pneumonia in patients with hemoblastosis develops into the stage of induced agranulocytosis. The special features of pneumonia during this time period are their atypical, severe and lingering course, often complicated by sepsis and toxic shock syndrome. In such patients, a characteristic auscultatory picture of the inflammatory process in the lungs is often absent; in a traditional X-ray examination, it is also not possible to detect infiltration. In patients with agranulocytosis in the presence of fever, computed tomography of the lungs should be performed regardless of the auscultatory picture and without prior radiography.

Conclusion. With timely diagnosis of the inflammatory process in the lungs of patients with hemoblastoses, compliance with the appropriate sanitary and hygienic regimen, the availability of modern antibacterial and antimycotic drugs, granulocyte colony stimulating factor drugs and other concomitant therapy, the prognosis of pneumonia is favorable in most cases (in the absence of uncontrolled tumor growth).

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