From the Guidelines
Common causes of death in patients with acute leukemia include infections, bleeding complications, and organ failure, with infections being a major contributor due to neutropenia, as noted in the 2021 guidelines by the National Comprehensive Cancer Network 1. Infections are particularly dangerous due to neutropenia (low white blood cell counts) from both the disease and its treatment, with bacterial infections like Pseudomonas, fungal infections such as Aspergillus, and viral infections being common.
- Bleeding complications occur due to thrombocytopenia (low platelet counts), which can lead to fatal hemorrhages, especially intracranial bleeding, as discussed in the 2001 guidelines for platelet transfusion by the American Society of Clinical Oncology 1.
- Organ failure may develop from leukemic infiltration of vital organs or as a complication of treatment, with respiratory failure, liver failure, and kidney failure being most common.
- Tumor lysis syndrome can occur during initial treatment, causing metabolic abnormalities that may lead to cardiac arrhythmias and death. Additionally, treatment-related mortality from chemotherapy toxicity, stem cell transplantation complications, and graft-versus-host disease contributes to mortality, as outlined in the 2017 NCCN guidelines for acute myeloid leukemia 1. Disease progression or relapse after treatment remains a significant cause of death, particularly in cases resistant to standard therapies, highlighting the importance of early recognition and intervention, as emphasized in the 2016 guidelines for prevention and treatment of cancer-related infections 1. Early recognition of these complications and prompt intervention with appropriate antimicrobials, blood product support, and organ-supportive care is essential to improve survival outcomes.
From the Research
Common Causes of Death in Acute Leukemia
The common causes of death in patients with acute leukemia include:
- Infection, which is the most common cause of death, accounting for 75% of cases 2
- Hemorrhage, which is mostly due to thrombocytopenia (61%) and disseminated intravascular coagulation (12%) 2
- Organ failure, which occurs in 9% of cases 2
- Septicemia, which is a major cause of early death in patients with acute myelogenous leukemia 3
- Drug-resistant disease associated with intractable local infection, which is a significant cause of early death in patients with acute myelogenous leukemia 3
Risk Factors for Death in Acute Leukemia
Several risk factors increase the likelihood of death in patients with acute leukemia, including:
- Age at the time of diagnosis, with older patients having a poorer prognosis 4
- Leukemia cell karyotype, with certain abnormalities associated with a poorer outcome 4
- Whether the leukemia is de novo or secondary, with secondary leukemia having a poorer prognosis 4
- Terminal neutrophil count, with patients having a count of less than 100/mm3 being more likely to die of infection 2
Treatment-Related Complications
Treatment for acute leukemia can also lead to complications that increase the risk of death, including: