Min Hyuk Choi1,2, Yeon Hwa Choe3, Yongjung Park2, Hyunjin Nah1, Sinyoung Kim1, Seok Hoon Jeong1, Hyun Ok Kim1. 1. Departments of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea. 2. Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea. 3. Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Hyperleukocytosis in acute leukemia is associated with higher early mortality due to the major complications of leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulopathy (DIC). Leukapheresis remains an important modality for the management of patients with acute leukemia and hyperleukocytosis. However, the role of leukapheresis in early mortality is controversial. This study sought to evaluate the prognostic impact of leukapheresis and its beneficial effects on TLS and DIC. STUDY DESIGN AND METHODS: We conducted a propensity score-matched study of 166 patients with acute leukemia and hyperleukocytosis admitted between 2006 and 2016. The incidence of TLS and DIC was determined using well-defined Cairo-Bishop criteria for TLS and International Society of Thrombosis and Haemostasis criteria for DIC. RESULTS: Before matching, 27 of 91 patients (30%) with acute myeloid leukemia (AML) and 32 of 75 patients (43%) with acute lymphoblastic leukemia (ALL) underwent leukapheresis. Propensity score matching was performed to adjust for clinical disparities between the leukapheresis and without-leukapheresis groups and resulted in 22 matched pairs of patients with AML and 16 matched pairs of patients with ALL. After matching, we observed no significant difference in early mortality rates or in the incidence of TLS or DIC between the two groups of patients with AML and ALL. CONCLUSION: Although leukapheresis may rapidly reduce white blood cell counts and leukemic blasts, any positive influence of leukapheresis could not be demonstrated by an effect on survival outcome and the incidence of early complications, such as TLS and DIC. These results suggest that a routinely performed, prophylactic leukapheresis cannot be recommended.
BACKGROUND:Hyperleukocytosis in acute leukemia is associated with higher early mortality due to the major complications of leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulopathy (DIC). Leukapheresis remains an important modality for the management of patients with acute leukemia and hyperleukocytosis. However, the role of leukapheresis in early mortality is controversial. This study sought to evaluate the prognostic impact of leukapheresis and its beneficial effects on TLS and DIC. STUDY DESIGN AND METHODS: We conducted a propensity score-matched study of 166 patients with acute leukemia and hyperleukocytosis admitted between 2006 and 2016. The incidence of TLS and DIC was determined using well-defined Cairo-Bishop criteria for TLS and International Society of Thrombosis and Haemostasis criteria for DIC. RESULTS: Before matching, 27 of 91 patients (30%) with acute myeloid leukemia (AML) and 32 of 75 patients (43%) with acute lymphoblastic leukemia (ALL) underwent leukapheresis. Propensity score matching was performed to adjust for clinical disparities between the leukapheresis and without-leukapheresis groups and resulted in 22 matched pairs of patients with AML and 16 matched pairs of patients with ALL. After matching, we observed no significant difference in early mortality rates or in the incidence of TLS or DIC between the two groups of patients with AML and ALL. CONCLUSION: Although leukapheresis may rapidly reduce white blood cell counts and leukemic blasts, any positive influence of leukapheresis could not be demonstrated by an effect on survival outcome and the incidence of early complications, such as TLS and DIC. These results suggest that a routinely performed, prophylactic leukapheresis cannot be recommended.
Authors: Rory M Shallis; Maximilian Stahl; Wei Wei; Pau Montesinos; Etienne Lengline; Judith Neukirchen; Vijaya R Bhatt; Mikkael A Sekeres; Amir T Fathi; Heiko Konig; Selina Luger; Irum Khan; Gail J Roboz; Thomas Cluzeau; David Martínez-Cuadron; Emmanuel Raffoux; Ulrich Germing; Jayadev Manikkam Umakanthan; Sudipto Mukhereje; Andrew M Brunner; Adam Miller; Christine M McMahon; Ellen K Ritchie; Rebeca Rodríguez-Veiga; Raphaël Itzykson; Blanca Boluda; Florence Rabian; Mar Tormo; Evelyn Acuña-Cruz; Emma Rabinovich; Brendan Yoo; Isabel Cano; Nikolai A Podoltsev; Jan Philipp Bewersdorf; Steven Gore; Amer M Zeidan Journal: Leuk Lymphoma Date: 2020-02-26
Authors: Takuto Takahashi; Lucie M Turcotte; Peter M Gordon; Andrew D Johnson; Nathan Rubin; Logan G Spector Journal: J Pediatr Hematol Oncol Date: 2022-03-01 Impact factor: 1.170