Hidemitsu Kurosawa1, Akihiko Tanizawa2, Chikako Tono3, Akihiro Watanabe4, Haruko Shima5, Masaki Ito6, Yuki Yuza7, Noriko Hotta8, Hideki Muramatsu9, Masahiko Okada10, Ryosuke Kajiwara11, Akiko Moriya Saito12, Shuki Mizutani13, Souichi Adachi14, Keizo Horibe12, Eiichi Ishii15, Hiroyuki Shimada5. 1. Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi, Japan. 2. Department of Pediatrics, University of Fukui Faculty of Medical Sciences, Fukui, Japan. 3. Department of Pediatrics, Iwate Prefectural Chube Hospital, Iwate, Japan. 4. Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan. 5. Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan. 6. Department of Pediatrics, Soma General Hospital, Fukushima, Japan. 7. Department of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 8. Department of Pediatrics, Japan Community Healthcare Organization Tokuyama Central Hospital, Tokuyama, Japan. 9. Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan. 10. Department of Pediatrics, Nagasaki University School of Medicine, Nagasaki, Japan. 11. Department of Pediatrics, Yokohama City University, Yokohama, Japan. 12. Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan. 13. Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan. 14. Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 15. Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan.
Abstract
BACKGROUND: The details of leukostasis in children and adolescents with chronic myeloid leukemia (CML) are unknown. This study determined the characteristics of leukostasis in children and adolescents with CML. PROCEDURE: A total of 256 cases from a retrospective study of patients with CML conducted by the Japanese Pediatric Leukemia/Lymphoma Study Group from 1996 to 2011 were analyzed, and of these, 238 cases were evaluated in this study. RESULTS: Leukostasis was diagnosed in 23 patients (9.7%). The median leukocyte count and spleen size below the left costal margin in cases with leukostasis were significantly higher and larger when compared to those in cases without leukostasis (458.5 × 10(9) /l vs. 151.8 × 10(9) /l (P < 0.01), and 13 vs. 5 cm (P < 0.01), respectively). Leukostasis occurred with ocular symptoms in 14 cases, priapism in four cases, and dyspnea, syncope, headache, knee pain, difficulty hearing, and aseptic necrosis of the femoral head in one case each. One case had two leukostasis symptoms simultaneously. Three cases were diagnosed before imatinib became available. Five cases received special treatment, and in the remaining 15 cases, all of these symptoms resolved after treatment with imatinib. CONCLUSIONS: This retrospective study represents the largest series of children and adolescents in which leukostasis of CML has been reported. Our data provide useful insight into the characteristics of leukostasis in recent cases of children and adolescents with CML.
BACKGROUND: The details of leukostasis in children and adolescents with chronic myeloid leukemia (CML) are unknown. This study determined the characteristics of leukostasis in children and adolescents with CML. PROCEDURE: A total of 256 cases from a retrospective study of patients with CML conducted by the Japanese Pediatric Leukemia/Lymphoma Study Group from 1996 to 2011 were analyzed, and of these, 238 cases were evaluated in this study. RESULTS:Leukostasis was diagnosed in 23 patients (9.7%). The median leukocyte count and spleen size below the left costal margin in cases with leukostasis were significantly higher and larger when compared to those in cases without leukostasis (458.5 × 10(9) /l vs. 151.8 × 10(9) /l (P < 0.01), and 13 vs. 5 cm (P < 0.01), respectively). Leukostasis occurred with ocular symptoms in 14 cases, priapism in four cases, and dyspnea, syncope, headache, knee pain, difficulty hearing, and aseptic necrosis of the femoral head in one case each. One case had two leukostasis symptoms simultaneously. Three cases were diagnosed before imatinib became available. Five cases received special treatment, and in the remaining 15 cases, all of these symptoms resolved after treatment with imatinib. CONCLUSIONS: This retrospective study represents the largest series of children and adolescents in which leukostasis of CML has been reported. Our data provide useful insight into the characteristics of leukostasis in recent cases of children and adolescents with CML.
Authors: Michael R Minckler; Ellie Conser; Javier J Figueroa; Aaron J Scott; Joshua Gaither; Richard Amini Journal: Case Rep Emerg Med Date: 2017-05-30