Acute respiratory failure developed in two patients with hyperleukocytic acute myelomonocytic leukemia with abnormal marrow eosinophils within 1 to 3 days after the beginning of high-dose induction chemotherapy. The presence of moderate pulmonary leukostasis before chemotherapy initiation, the simultaneous occurrence of an acute tumor lysis syndrome, the lack of evidence of any other cause of respiratory distress, and the clinical evolution lead the authors to attribute pulmonary injury to lysis of resident leukemic cells. The responsibility of eosinophilic cellular constituents for the diffuse alveolar damage is discussed. Cancer 1992; 69:1356-1361.
Pulmonary complications occumng at the time of diagnosis or within the first 3 days after the initiation of chemotherapy in patients with acute leukemia may result from various etiologic factors, including infection, specific pulmonary parenchymal infiltration by leukemic blast cells,' pulmonary vascular leuko~tasis,'-~ intraparenchymal or intraalveolar pulmonary overload, chemotherapy toxicity, or pulmonary leukemic cell l ~s i s . ~ Different contributory causes often are associated in the genesis of respiratory failure at the time of the leukemic course. Some of the specific neoplastic causes of respiratory failure (i.e., infiltration and leukostasis) will improve with rapid administration of cytotoxic agents, with or without prior therapeutic leukapheresis. ',' In contrast, pulmonary complications,