PURPOSE: Adult T cell leukemia/lymphoma (ATLL) is one manifestation of infection by the HTLV-I retrovirus endemic in Asia and the Caribbean. Kings County Hospital Center(KCHC) is an inner city hospital in Brooklyn, NY, that serves a large Caribbean population. Standard combination chemotherapy induces a short lived response followed by rapidly fatal systemic relapse. The median survival with therapy is approximately 6 months. In our experience, the relentless course of ATLL is not altered by MICU care. The outcomes of patients with ATLL admitted to MICU were evaluated to determine the utility of intensive care.
METHODS: Clinical data and outcome variables were extracted from the medical records of 18 adult patients admitted to the medical intensive care unit(MICU) at KCH from July 2005 until July 2009. Data is presented as mean±SD.
RESULTS: 18 patients (10 women) with an average age of 59±12 years were admitted to the MICU. The majority of them (17 out of 18) died during that admission with an average ICU length of stay of 9.5±6.9 days. Upon MICU admission most patients had respiratory failure (90%) shock (70%), lactic acidosis (8.1±5 mmol/L), acute renal failure (27%), overt DIC (75%). Patient also had hypercalcemia (12.7±2.4 mg/dL) and increased LDH (2248±2289 IU/L). Most patients received combination chemotherapy (EPOCH) (75%). The median survival was 1.5 months reflects the aggressive, treatment resistant nature of this disease. The only patient who survived MICU admission did not have cardiorespiratory failure or overt DIC.
CONCLUSION: Adult T cell lymphoma/leukemia is an aggressive disease with a dismal prognosis. Patients admitted to the MICU with sepsis and multiorgan failure invariably die in the unit. Until more effective treatments are developed for ATLL, MICU does not alter the course of disease. Palliative care services should be involved early to prepare patients and families to avoid traumatic fruitless and costly MICU admissions.
CLINICAL IMPLICATIONS: With the increasing cost in health care, it is imperative to identify patients with futile prognosis and involve the palliative care service early in their care.
DISCLOSURE: George Apergis, No Financial Disclosure Information; No Product/Research Disclosure Information