Annals of Hematology

, Volume 98, Issue 1, pp 119–129 | Cite as

Autopsy findings in patients with acute myeloid leukemia and non-Hodgkin lymphoma in the modern era: a focus on lung pathology and acute respiratory failure

  • Andry Van de LouwEmail author
  • Allyson M. Lewis
  • Zhaohai Yang
Original Article


We aimed to report autopsy findings in patients with acute myeloid leukemia (AML) and non-Hodgkin lymphoma (NHL) in the modern era, and also to focus on lung pathology in the subgroup of patients with acute respiratory failure (ARF) of unknown etiology, which is associated with especially high mortality rates. Charts and autopsy reports of 107 patients (59 AML and 48 NHL) autopsied between 2003 and 2018 were reviewed. More than 50% of patients had missed major diagnoses found at autopsy with 95% of lungs displaying abnormal findings. Malignant infiltration in at least one organ was observed in about 70% of patients with either no complete remission or relapse at the time of death (n = 92) versus 20% in patients without signs of active malignancy (n = 15) (p = 0.001). In patients with ARF of unknown etiology (n = 59), the proportion of malignant lung infiltration was 27% and equilibrated with bacterial pneumonias (29%), fungal pneumonias represented 8%, and isolated alveolar damage or pulmonary edema were the only findings in 32% of patients. Overall, 85% of patients with ARF of unknown etiology had either relapsed or not achieved remission at time of death and 80% of patients with malignant lung infiltration had ARF of unknown etiology. Ninety percent of malignant infiltration and fungal infections were observed in patients with no complete remission or relapse. Autopsy remains valuable in AML and NHL patients; besides infections, malignant infiltration is a significant contributor to ARF of unknown etiology and is rarely diagnosed ante mortem.


Acute myeloid leukemia Non-Hodgkin lymphoma Autopsy Acute respiratory failure Lung pathology 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


  1. 1.
    Azoulay E, Mokart D, Pene F, Lambert J, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Laisne LM, Rabbat A, Lebert C, Perez P, Chaize M, Renault A, Meert AP, Benoit D, Hamidfar R, Jourdain M, Darmon M, Schlemmer B, Chevret S, Lemiale V (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol 31(22):2810–2818. CrossRefGoogle Scholar
  2. 2.
    Contejean A, Lemiale V, Resche-Rigon M, Mokart D, Pene F, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Hamidfar R, Darmon M, Jourdain M, Renault A, Schlemmer B, Azoulay E (2016) Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology: a Groupe de Recherche en Reanimation Respiratoire en Onco-Hematologique (Grrr-OH) study. Ann Intensive Care 6(1):102. CrossRefGoogle Scholar
  3. 3.
    Azoulay E, Pickkers P, Soares M, Perner A, Rello J, Bauer PR, van de Louw A, Hemelaar P, Lemiale V, Taccone FS, Martin Loeches I, Meyhoff TS, Salluh J, Schellongowski P, Rusinova K, Terzi N, Mehta S, Antonelli M, Kouatchet A, Barratt-Due A, Valkonen M, Landburg PP, Bruneel F, Bukan RB, Pene F, Metaxa V, Moreau AS, Souppart V, Burghi G, Girault C, Silva UVA, Montini L, Barbier F, Nielsen LB, Gaborit B, Mokart D, Chevret S, Efraim i, the nine Isg (2017) Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study. Intensive Care Med 43(12):1808–1819. CrossRefGoogle Scholar
  4. 4.
    Azoulay E, Mokart D, Lambert J, Lemiale V, Rabbat A, Kouatchet A, Vincent F, Gruson D, Bruneel F, Epinette-Branche G, Lafabrie A, Hamidfar-Roy R, Cracco C, Renard B, Tonnelier JM, Blot F, Chevret S, Schlemmer B (2010) Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 182(8):1038–1046. CrossRefGoogle Scholar
  5. 5.
    LC MK Jr, Collins RD (1974) Intravascular leukocyte thrombi and aggregates as a cause of morbidity and mortality in leukemia. Medicine (Baltimore) 53(6):463–478CrossRefGoogle Scholar
  6. 6.
    Barcos M, Lane W, Gomez GA, Han T, Freeman A, Preisler H, Henderson E (1987) An autopsy study of 1206 acute and chronic leukemias (1958 to 1982). Cancer 60(4):827–837CrossRefGoogle Scholar
  7. 7.
    Yates JW, Wallace HJ Jr, Ellison RR, Holland JF (1973) Cytosine arabinoside (NSC-63878) and daunorubicin (NSC-83142) therapy in acute nonlymphocytic leukemia. Cancer Chemother Rep 57(4):485–488Google Scholar
  8. 8.
    Goldman L, Sayson R, Robbins S, Cohn LH, Bettmann M, Weisberg M (1983) The value of the autopsy in three medical eras. N Engl J Med 308(17):1000–1005. CrossRefGoogle Scholar
  9. 9.
    Pastores SM, Dulu A, Voigt L, Raoof N, Alicea M, Halpern NA (2007) Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients. Crit Care 11(2):R48. CrossRefGoogle Scholar
  10. 10.
    Shojania KG, Burton EC, McDonald KM, Goldman L (2003) Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA 289(21):2849–2856. CrossRefGoogle Scholar
  11. 11.
    Groch SN, Sayre GP, Heck FJ (1960) Cerebral hemorrhage in leukemia. Arch Neurol 2:439–451CrossRefGoogle Scholar
  12. 12.
    Combes A, Mokhtari M, Couvelard A, Trouillet JL, Baudot J, Henin D, Gibert C, Chastre J (2004) Clinical and autopsy diagnoses in the intensive care unit: a prospective study. Arch Intern Med 164(4):389–392. CrossRefGoogle Scholar
  13. 13.
    Sharma S, Nadrous HF, Peters SG, Tefferi A, Litzow MR, Aubry MC, Afessa B (2005) Pulmonary complications in adult blood and marrow transplant recipients: autopsy findings. Chest 128(3):1385–1392. CrossRefGoogle Scholar
  14. 14.
    Azoulay E, Lemiale V, Mokart D, Pene F, Kouatchet A, Perez P, Vincent F, Mayaux J, Benoit D, Bruneel F, Meert AP, Nyunga M, Rabbat A, Darmon M (2014) Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 40(8):1106–1114. CrossRefGoogle Scholar
  15. 15.
    Chamilos G, Luna M, Lewis RE, Bodey GP, Chemaly R, Tarrand JJ, Safdar A, Raad II, Kontoyiannis DP (2006) Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003). Haematologica 91(7):986–989Google Scholar
  16. 16.
    Lass-Florl C, Resch G, Nachbaur D, Mayr A, Gastl G, Auberger J, Bialek R, Freund MC (2007) The value of computed tomography-guided percutaneous lung biopsy for diagnosis of invasive fungal infection in immunocompromised patients. Clin Infect Dis 45(7):e101–e104. CrossRefGoogle Scholar
  17. 17.
    White DA, Wong PW, Downey R (2000) The utility of open lung biopsy in patients with hematologic malignancies. Am J Respir Crit Care Med 161(3 Pt 1):723–729. CrossRefGoogle Scholar
  18. 18.
    Panoskaltsis-Mortari A, Griese M, Madtes DK, Belperio JA, Haddad IY, Folz RJ, Cooke KR, American Thoracic Society Committee on Idiopathic Pneumonia S (2011) An official American Thoracic Society research statement: noninfectious lung injury after hematopoietic stem cell transplantation: idiopathic pneumonia syndrome. Am J Respir Crit Care Med 183(9):1262–1279. CrossRefGoogle Scholar
  19. 19.
    Limper AH (2004) Chemotherapy-induced lung disease. Clin Chest Med 25(1):53–64. CrossRefGoogle Scholar
  20. 20.
    Gupta S, Sultenfuss M, Romaguera JE, Ensor J, Krishnamurthy S, Wallace MJ, Ahrar K, Madoff DC, Murthy R, Hicks ME (2010) CT-guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions. Hematol Oncol 28(2):75–81. Google Scholar
  21. 21.
    Muehlstaedt M, Bruening R, Diebold J, Mueller A, Helmberger T, Reiser M (2002) CT/fluoroscopy-guided transthoracic needle biopsy: sensitivity and complication rate in 98 procedures. J Comput Assist Tomogr 26(2):191–196CrossRefGoogle Scholar
  22. 22.
    Moreau AS, Peyrony O, Lemiale V, Zafrani L, Azoulay E (2017) Acute respiratory failure in patients with hematologic malignancies. Clin Chest Med 38(2):355–362. CrossRefGoogle Scholar
  23. 23.
    Heussel CP, Kauczor HU, Heussel GE, Fischer B, Begrich M, Mildenberger P, Thelen M (1999) Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. J Clin Oncol 17(3):796–805. CrossRefGoogle Scholar
  24. 24.
    Pirozynski M (1992) Bronchoalveolar lavage in the diagnosis of peripheral, primary lung cancer. Chest 102(2):372–374CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicinePennsylvania State University College of Medicine and Milton S. Hershey Medical CenterHersheyUSA
  2. 2.Department of PathologyPennsylvania State University College of Medicine and Milton S. Hershey Medical CenterHersheyUSA

Personalised recommendations