Corticosteroid Therapy for Diffuse Alveolar Hemorrhage with Respiratory Failure in Hematologic Malignancies: A Retrospective Cohort Study.

Background: Although DAH in hematopoietic stem cell transplantation recipients is commonly treated with systemic corticosteroids, the efficacy of steroid therapy on DAH with respiratory failure in hematologic malignancy patients has not been studied. We aimed to investigate the effectiveness of steroid therapy in hematologic malignancy patients who developed DAH with respiratory failure and required treatment in the intensive care unit (ICU).

Methods: Among DAH patients with leukemia, lymphoma, or multiple myeloma, those who were not admitted to the ICU were excluded. Included patients were classified into the steroid or control group according to steroid therapy. Patient data were retrospectively collected from electrical medical records. The primary outcome was ICU mortality.

Results: A total of 44 patients (steroid group, n = 32; control group, n = 12) were included. At the DAH diagnosis, the steroid group was less likely to have a history of previously treated solid malignancy (3% vs 25%; P = 0.025) compared to the control group. ICU mortality in the steroid group was not significantly different from that in the control group (66% vs 67%; P = 0.948). Only in the steroid group, the ratio of arterial oxygen partial pressure to fractional inspired oxygen was significantly improved after 2 days from the DAH diagnosis (151 ± 64 vs 120 ± 38 mm Hg; P = 0.039).

Conclusion: Hematologic malignancy patients who developed DAH with respiratory failure and were admitted to the ICU had high mortality, irrespective of steroid therapy.