(1177) Rapid Respiratory Decline Following Cytarabine Treatment in Acute Myeloid Leukemia

Introduction: Cytarabine is a key medication in the treatment of acute myeloid leukemia. It's part of the anthracycline medication class and acts as both an antimetabolite and an antineoplastic agent. Diffuse alveolar hemorrhage during cytarabine administration is extremely rare, with only a few case cases documented. Cytarabine-induced damage to the alveolar-capillary membrane is thought to be cytokine-dependent.

Description: A case of a 50-year-old woman recently diagnosed with acute myeloid leukemia (AML) was admitted to the Hematology-Oncology ward and later transferred to the MICU due to respiratory distress. Imaging showed multifocal, ill-defined alveolar opacities in both lungs, indicative of bilateral acute pneumonia. Consequently, her antibiotic regimen was escalated to broad spectrum antibiotics. A chest CT revealed multiple bilateral airspace opacities, diffuse consolidation, and small pleural effusions. Due to respiratory deterioration she was placed on a high-flow nasal cannula (HFNC) with 50% oxygen. Given her high bleeding risk and the possibility of diffuse alveolar hemorrhage vs leukemia infiltration into the lungs, a single dose of Cytarabine 1.7g was administered. After discussing the risks and benefits, the patient consented to the treatment. Aminocaproic acid 5g IV was also given, and recombinant factor VIIa was ordered but it was not available in the institution. Two hours after Cytarabine administration, the patient developed tachypnea despite HFNC at 90% oxygen and 45L/min flow. She was rapidly intubated, and lung protective ventilation was initiated. Steroid pulsation with Solumedrol 125 mg IV every 6 hours was started. After a brief stabilizing period lasting two hours, the patient went into cardiorespiratory arrest. Cardiopulmonary resuscitation was initiated for pulseless electrical activity. During resuscitation, fresh blood continuously flooded from her endotracheal tube, suggesting diffuse alveolar hemorrhage. Despite efforts, the patient unfortunately passed away.

Discussion: Cytarabine has become essential for the treatment of acute myeloid leukemia (AML), although it may trigger severe adverse effects such as diffuse alveolar hemorrhage. This case emphasizes the need for further investigation to better understand and prevent Cytarabine-induced lung injury.