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Mack EA, Dougher MC, Ginda AM, Cahill C, Murter M, Schell K, Tanhehco YC, Bhoj VG, Fesnak AD, Siegel DL, Kambayashi T, Aqui NA, O'Doherty U. Red cell exchange for rapid leukoreduction in adults with hyperleukocytosis and leukostasis. Blood 2024; 143:1049-1054. [PMID: 38052031 DOI: 10.1182/blood.2023021895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
ABSTRACT We show that red cell exchange (RCE) treats hyperleukocytosis in acute leukemia. RCE provided similar leukoreduction to standard therapeutic leukoreduction and could be superior in patients with severe anemia or monocytic leukemias or when requiring rapid treatment.
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Affiliation(s)
- Ethan A Mack
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Meaghan C Dougher
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ashley M Ginda
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Caitlin Cahill
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Melissa Murter
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kevin Schell
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Yvette C Tanhehco
- Division of Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Vijay G Bhoj
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Andrew D Fesnak
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Don L Siegel
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Taku Kambayashi
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Nicole A Aqui
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Una O'Doherty
- Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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2
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Farid KMN, Sauer T, Schmitt M, Müller-Tidow C, Schmitt A. Symptomatic Patients with Hyperleukocytic FLT3-ITD Mutated Acute Myeloid Leukemia Might Benefit from Leukapheresis. Cancers (Basel) 2023; 16:58. [PMID: 38201486 PMCID: PMC10778499 DOI: 10.3390/cancers16010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE We aimed to identify subsets of patients who benefit from emergency LA and to establish a therapeutic algorithm for AML patients with hyperleukocytosis. METHODS In this single-center retrospective cohort study, a total of 20 consecutive patients underwent LA because of their clinical symptoms. Overall survival (OS) analysis was conducted using the Kaplan-Meier plot method. Univariate and multivariate analyses (using multiple logistic regression) were performed. At the time of diagnosis, all patients received a standard diagnostic workup for AML including FLT3-ITD mutational analysis. RESULTS FLT3-ITD mut AML patients receiving LA had a median OS of 437 days (range 5-2379 days) with a corresponding 14-day survival of 92.3%, while FLT3 wt AML patients displayed a significantly lower median OS of only 5 days (range 1-203 days) with a corresponding 14-day survival of 14.3% (p = 0.0001). CONCLUSIONS Among patients with clinical symptoms of leukostasis, the subset of FLT3-ITD mut AML patients showed a better outcome with lower early mortality after emergency LA. Based on these observations, we established a therapeutic algorithm for AML patients with hyperleukocytosis.
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Affiliation(s)
| | - Tim Sauer
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Michael Schmitt
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany
- German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Anita Schmitt
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany
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3
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Jeon WJ, Dalal S, Moon JH, Joung B, Nguyen M, Castillo D, Hudson J, Park K, Raghavan R, Akhtari M, Patel A. Leukostasis With Isolated Central Nervous System Involvement in Chronic Phase of Chronic Myelogenous Leukemia. J Hematol 2023; 12:187-196. [PMID: 37692864 PMCID: PMC10482607 DOI: 10.14740/jh1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/11/2023] [Indexed: 09/12/2023] Open
Abstract
Chronic myelogenous leukemia (CML) is a hematologic malignancy with unique significance to the field of hematology and oncology, specifically due to the development of tyrosine kinase inhibitors (TKIs). CML often presents with nonspecific symptoms, and the quality of life in patients with CML has drastically improved as a result of TKIs. However, complications of CML including the risk of transforming into life-threatening blast crises continue to exist. Further, as most patients are asymptomatic in the chronic phase, patients often present with serious complications associated with noncompliance to TKIs. For example, central nervous system (CNS) manifestations of CML have been reported, both as the initial presentation of undiagnosed CML and as known complication of uncontrolled CML. Hyperleukocytosis is a manifestation of uncontrolled CML and leukostasis is a complication, occurring in cases of acute myeloid leukemia (AML). Here we present a rare case of leukostasis in a patient with known CML presenting on computed tomography (CT) as intracranial masses in the chronic phase. Our goal is to discuss this rare case of leukostasis in adult CML and describe its management.
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Affiliation(s)
- Won Jin Jeon
- Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Suhani Dalal
- Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Jin Hyun Moon
- Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Bowon Joung
- Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Michael Nguyen
- Division of Medical Oncology/Hematology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Dani Castillo
- Division of Medical Oncology, City of Hope, Duarte, CA, USA
| | - Jessica Hudson
- Division of Anatomic and Surgical Pathology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Kiwon Park
- Department of Pharmacy, Loma Linda University, Loma Linda, CA, USA
| | - Ravi Raghavan
- Division of Anatomic and Surgical Pathology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Mojtaba Akhtari
- Division of Medical Oncology/Hematology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Ami Patel
- Division of Medical Oncology/Hematology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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4
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Analysis of Risk Factors of Coagulation Dysfunction and Hemorrhage in Newly Diagnosed Hyperleukocytic Acute Myeloma Leukemia. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7828230. [PMID: 35935316 PMCID: PMC9300275 DOI: 10.1155/2022/7828230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 11/22/2022]
Abstract
Purpose To explore whether and why abnormal coagulation function and hemorrhage can appear in patients with hyperleukocytic acute myeloid leukemia (HAML). Method We retrospectively reviewed the charts of 724 acute myeloid leukemia (AML) patients admitted with a white blood cell count of >100 × 109/L between 2010 and 2019 in order to analyze the coagulation index of patients with HAML and explore the correlation of abnormal coagulation. Result Prothrombin time (PT) was extended in group HAML compared with group non-HAML. Respiratory failure, intracranial hemorrhage, and infection were more common in the HAML group. Among the 76 HAML patients, there were 33 patients who had ≥3 abnormal items of coagulation index, and 51.5% of them had level 2 hemorrhage which was more than level 0 hemorrhage, and the difference is statistically significant (P < 0.01). Similarly, we can discover that 40.9% of patients with 2 abnormal items had level 2 hemorrhage in contrast to 0 abnormal items. The use of hydroxyurea had a significant effect on PT and D-dimer (DD). Survival analysis by the Kaplan–Meier method showed that there were statistically significant differences in white blood cell (WBC) count>200 × 109//L and DD. Abnormal PT is associated with WBC count>200 × 109//L, and abnormal activated partial thromboplastin time (APTT) is associated with HLA-DR mutation. Infection and respiratory failure were independent influencing factors for the coagulation of patients. Conclusion DD had a marked effect on the survival rate. Infection and respiratory failure were independent influencing factors for the coagulation of patients.
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5
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Macaron W, Sargsyan Z, Short NJ. Hyperleukocytosis and leukostasis in acute and chronic leukemias. Leuk Lymphoma 2022; 63:1780-1791. [DOI: 10.1080/10428194.2022.2056178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Walid Macaron
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zaven Sargsyan
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nicholas J. Short
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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6
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Zhang X, Tu Y, Shen J, Feng Y, Ma H, Bai L, Li X, Lin Z, Dai L, Gong F, Lu T, Zhou J, Chen H, Lv Q, Zhu Z, Ruan C. Effectiveness and safety of leukapheresis in hyperleukocytic leukemias: a retrospective multicenter study. Leuk Lymphoma 2022; 63:2636-2644. [PMID: 35731036 DOI: 10.1080/10428194.2022.2086246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Leukapheresis is an effective adjuvant therapy for leukemia patients with hyperleukocytosis, but few studies have reported recent data with modern modalities and comparisons among different leukemia types. We conducted a retrospective study on leukapheresis among 420 patients with AML, ALL and CML in four local centers. WBC counts decreased significantly (p < 0.001) postleukapheresis in all three cohorts. Clearance efficiency was higher in acute leukemia patients than CML patients (p < 0.01). Concomitant leukocytoreduction drugs improved WBC reduction only in AML patients (p < 0.05). Leukocyte, hemoglobin and platelet levels preleukapheresis might affect the clearance efficiency in AML and/or ALL patients. Hematological toxicities were the major concerns, but most of them were mild, and only 11 patients died of all causes within one week postleukapheresis. In conclusion, leukapheresis can safely reduce the leukemic burden, especially for patients with acute leukemias.
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Affiliation(s)
- Xiang Zhang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Stem Cells and Biomedical, Materials of Jiangsu Province and Chinese Ministry of Science and Technology, Suzhou, China
| | - Yuqing Tu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Stem Cells and Biomedical, Materials of Jiangsu Province and Chinese Ministry of Science and Technology, Suzhou, China
| | - Juan Shen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yufeng Feng
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Houshi Ma
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Lian Bai
- Department of Hematology, Suzhou Canglang Hospital, Suzhou, China
| | - Xiaoli Li
- Department of Hematology, Suzhou Hongci Blood Disease Hospital, Suzhou, China
| | - Zhihong Lin
- Department of Hematology, Suzhou Yongding Hospital, Suzhou, China
| | - Lijun Dai
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feiran Gong
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tianyu Lu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Hematology, Suzhou Hongci Blood Disease Hospital, Suzhou, China
| | - Jiazi Zhou
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hanqing Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Hematology, Suzhou Hongci Blood Disease Hospital, Suzhou, China
| | - Quansheng Lv
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziling Zhu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Changgeng Ruan
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Stem Cells and Biomedical, Materials of Jiangsu Province and Chinese Ministry of Science and Technology, Suzhou, China
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7
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Takahashi T, Turcotte LM, Gordon PM, Johnson AD, Rubin N, Spector LG. Therapeutic Leukapheresis in Pediatric Leukemia: Utilization Trend and Early Outcomes in a US Nationwide Cohort. J Pediatr Hematol Oncol 2022; 44:47-53. [PMID: 33735152 PMCID: PMC8568727 DOI: 10.1097/mph.0000000000002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
Leukapheresis (LA) in pediatric leukemia is performed for leukostasis, a life-threatening emergency in the setting of extremely increased blast cell counts. The authors aimed to assess the epidemiology of pediatric leukemia who received LA. The authors reviewed US nationally representative admission records of patients less than 20 years of age in the Kids' Inpatient Database for the years 2000, 2003, 2006, 2009, 2012, and 2016. Incidence of new leukemia cases who underwent LA were calculated for the years 2009, 2012, and 2016. Cox and logistic regression analyses were performed to ascertain the risk factors for adverse outcomes. There were 526 admissions for pediatric patients with acute lymphoblastic leukemia (ALL) (n=328), acute myeloid leukemia (AML) (n=124), or chronic myeloid leukemia (CML) (n=74) who underwent LA over the study period. The incidence of leukemia cases that required LA was lower in 2016 than in 2009 or 2012 (1.4%, 2.2%, and 2.7%, respectively; P=0.001). In-hospital mortality was higher in AML than ALL (hzard ratio, 3.2; 95% confidence interval, 1.1-9.1). None with CML died during admission. This first population-based study of LA in pediatric leukemia showed a decreased utilization of LA over recent years. The higher inpatient mortality in AML, as compared with ALL or CML, warrant further investigations.
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MESH Headings
- Child
- Humans
- Leukapheresis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Leukostasis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Retrospective Studies
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Affiliation(s)
- Takuto Takahashi
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Lucie M. Turcotte
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Peter M. Gordon
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Andrew D. Johnson
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
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8
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Zhang D, Zhu Y, Jin Y, Kaweme NM, Dong Y. Leukapheresis and Hyperleukocytosis, Past and Future. Int J Gen Med 2021; 14:3457-3467. [PMID: 34285568 PMCID: PMC8286901 DOI: 10.2147/ijgm.s321787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023] Open
Abstract
Hyperleukocytosis is a hematologic crisis caused by excessive proliferation of leukemic cells and has a relatively high early mortality due to a series of severe complications. Therefore, prompt and effective intervention is required. Leukapheresis performed using apheresis equipment to separate leukocytes from peripheral blood, at the same time returns autologous plasma, platelets and erythrocytes to the patient, is applied clinically for the treatment of hyperleukocytosis. Leukapheresis not only removes excessive leukocytes rapidly and corrects metabolic abnormalities but also alleviates the symptoms of leukostasis. In addition, the procedure of leukapheresis is generally well tolerated. Leukapheresis has become one of the most imperative adjuvant therapies to treat hyperleukocytosis, especially in the patient who was not inappropriate to cytoreduce with Ara-C or hydroxyurea. In this review, we present the background of leukapheresis development and highlight its clinical application in hyperleukocytic leukemia patients.
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Affiliation(s)
- Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
| | - Yufan Zhu
- Orthopedics department, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Yanxia Jin
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Natasha Mupeta Kaweme
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Youhong Dong
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
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9
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Tu YQ, Fan Y, Zhu ZL, Chen J, Song TM, Zhang X, Lu Y, Wu DP. [Efficacy and safety of leukapheresis for hyperleukocytic leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:161-164. [PMID: 33858049 PMCID: PMC8071669 DOI: 10.3760/cma.j.issn.0253-2727.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Y Q Tu
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Y Fan
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Z L Zhu
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - J Chen
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - T M Song
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - X Zhang
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Y Lu
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - D P Wu
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
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10
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Göçer M, Kurtoğlu E. Effect of prophylactic leukapheresis on early mortality and overall survival in acute leukemia patients with hyperleukocytosis. Ther Apher Dial 2021; 25:697-703. [PMID: 33686785 DOI: 10.1111/1744-9987.13645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
Hyperleukocytosis has been associated with early mortality owing to the presence of complications including leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulation (DIC). Leukapheresis is a fast and effective cytoreductive procedure that removes leukocytes from the peripheral circulation. This single-center, retrospective, and observational study included 32 patients diagnosed with acute leukemia who underwent leukapheresis due to hyperleukocytosis between 2014 and 2020. This study primarily aimed to investigate the effect of prophylactic leukapheresis on early mortality and overall survival (OS). In the symptomatic group, seven and two patients died in the first and second weeks, respectively. In the prophylactic leukapheresis group, two and one patients died in the first and second weeks (p = 0.792), respectively. OS was significantly longer in the prophylactic leukapheresis group (p = 0.004). The leukapheresis procedure appears to be effective on early mortality and OS. Initiation of prophylactic leukapheresis before the appearance of leukostasis symptoms is effective on OS and possibly early mortality.
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Affiliation(s)
- Mesut Göçer
- Department of Internal Medicine, Division of Hematology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Erdal Kurtoğlu
- Department of Internal Medicine, Division of Hematology, Antalya Training and Research Hospital, Antalya, Turkey
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11
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The factors influencing clinical outcomes after leukapheresis in acute leukaemia. Sci Rep 2021; 11:6426. [PMID: 33742034 PMCID: PMC7979875 DOI: 10.1038/s41598-021-85918-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/08/2021] [Indexed: 12/01/2022] Open
Abstract
Leukapheresis is used for the mechanical removal of leukaemic cells in hyperleukocytosis. However, the effectiveness of leukapheresis remains unclear due to selection and confounding factors in the cohorts. We compared the effectiveness of leukapheresis among the subgroups according to either the 2016 World Health Organization classification or the number of cytogenetic abnormalities with a retrospective, single-centre study from January 2009 to December 2018. Acute myeloid leukaemia (AML, n = 212) and acute lymphoblastic leukaemia (ALL, n = 97) were included. The 30-day survival rates (95% confidence interval, 95% CI) for AML and ALL were 86.3% (81.6–90.9%) and 94.8% (90.3–99.2%), respectively. For AML, ‘primary AML with myelodysplasia-related changes’ and ‘AML with biallelic mutation of CEBPA’ showed better 30-day survival outcomes (P = 0.026) than the other subgroups. A higher platelet count after leukapheresis was associated with better 30-day survival in AML patients (P = 0.029). A decrease in blast percentage count after leukapheresis was associated with better 30-day survival in ALL patients (P = 0.034). Our study suggested that prophylactic platelet transfusion to raise the platelet count to 50 × 109/L or greater might improve clinical outcome in AML patients undergoing leukapheresis.
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12
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Zhao J, Bewersdorf JP, Jaszczur S, Kowalski A, Perreault S, Schiffer M, Gore S, Podoltsev N, Prebet T, Shallis R, Zeidan AM. High dose cyclophosphamide for cytoreduction in patients with acute myeloid leukemia with hyperleukocytosis or leukostasis. Leuk Lymphoma 2020; 62:1195-1202. [PMID: 33325761 DOI: 10.1080/10428194.2020.1856835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hyperleukocytosis may lead to multiple medical emergencies. Hydroxyurea, intensive chemotherapy, and leukapheresis are used for cytoreduction. However, there is little data regarding the best approach. Here, we report on the efficacy and safety of high dose cyclophosphamide (HDCy; 60 mg/kg). 27 patients with acute myeloid leukemia or blast phase chronic myeloid leukemia who presented with white blood cell count (WBC) of ≥50x109/L or symptoms of leukostasis were treated with HDCy. Primary endpoint was early mortality (death within seven days of admission). Median WBC was 107 × 109/L at time of HDCy; 74% had leukostasis symptoms at presentation. Eight (29.6%) patients died within seven days of admission. Sustained WBC reduction was achieved in 18/24 (75%) evaluable patients with median nadir of 0.25 × 109/L. Adverse effects attributed to HDCy included tumor lysis syndrome (n = 7; 25.9%), disseminated intravascular coagulopathy (n = 5; 18.5%), and hemorrhagic cystitis (n = 1; 3.7%). HDCy was effective for cytoreduction and adverse effects were acceptable.
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Affiliation(s)
- Jennifer Zhao
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | | | - Sara Jaszczur
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Andrew Kowalski
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Sarah Perreault
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Molly Schiffer
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Steven Gore
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Nikolai Podoltsev
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Thomas Prebet
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Rory Shallis
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Amer M Zeidan
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, CT, USA
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13
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Jafari A, Rezaei-Tavirani M, Salimi M, Tavakkol R, Jafari Z. Oncological Emergencies from Pathophysiology and Diagnosis to Treatment: A Narrative Review. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:689-709. [PMID: 32967589 DOI: 10.1080/19371918.2020.1824844] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Oncological emergencies are defined as any acute possible morbid or life-threatening events in patients with cancer either because of the malignancy or because of their treatment. These events may occur at any time during malignancy, from symptoms present to end-stage disease. The aim of this study is the review of urgent conditions results from cancer or cancer treatment side effects that need to be addressed immediately. In this study, a comprehensive and in-depth narrative review was carried out by searching the databases of PubMed, Scopus, Science Direct, Google Scholar with the keywords of "cancer, emergency, metabolic emergency, neutropenic fever" along with the words, "tumor lysis syndrome, chemotherapeutic emergency, diagnosis, treatment " in last two decades. Patients suffering from cancer mostly face the challenges that we are classified in different categories, including metabolic, hematologic, cardiovascular, neurologic, respiratory, infectious, and chemotherapeutic emergencies. These patients mostly complain of headaches, nausea, pain, and fever. In conclusion, knowledge of oncology emergencies and palliative care as part of a team approach is critical for treating cancer patients. In this light, it is pivotal for physicians to focus on the early detection of oncological emergencies. Moreover, training programs for cancer patients help them to timely recognize and report the oncologic emergency symptoms, leading to avoid deleterious consequences and unnecessary healthcare costs as well as improve the quality of life in these patients.
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Affiliation(s)
- Ameneh Jafari
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran, Iran
- Proteomics Research Center, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Maryam Salimi
- Department of Biology and Anatomical Sciences, Faculty of Medicine, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Reza Tavakkol
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences , Larestan, Iran
| | - Zahra Jafari
- 9 dey Manzariye Hospital, Isfahan University of Medical Sciences , Isfahan, Iran
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14
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Bewersdorf JP, Giri S, Tallman MS, Zeidan AM, Stahl M. Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia—A systematic review and meta‐analysis. Transfusion 2020; 60:2360-2369. [DOI: 10.1111/trf.15994] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Jan P. Bewersdorf
- Department of Internal Medicine, Section of Hematology Yale School of Medicine New Haven Connecticut USA
| | - Smith Giri
- Division of Hematology and Oncology University of Alabama School of Medicine Birmingham Alabama USA
| | - Martin S. Tallman
- Leukemia Service Memorial Sloan Kettering Cancer Center New York New York USA
| | - Amer M. Zeidan
- Department of Internal Medicine, Section of Hematology Yale School of Medicine New Haven Connecticut USA
| | - Maximilian Stahl
- Leukemia Service Memorial Sloan Kettering Cancer Center New York New York USA
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15
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Szczepiorkowski ZM. Indications for therapeutic apheresis in hematological disorders. Semin Hematol 2020; 57:57-64. [PMID: 32892844 DOI: 10.1053/j.seminhematol.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The early apheresis devices were developed in 1930s, but therapeutic apheresis only became widely used decades later, when automated cell separators were introduced. Progress in technical development of these devices continues to this day. Initial use of therapeutic apheresis has not been evidence based. Documents such as the Guidelines by the American Society for Apheresis provided hematologist with better tools to assess the role of therapeutic apheresis in daily practice. This review focuses on the use of therapeutic apheresis in patients with hematological disorders. Four separate apheresis modalities most encountered by hematologists are discussed: therapeutic plasma exchange, therapeutic leukocytapheresis, red blood cell exchange, and extracorporeal photopheresis. Examples of indications are provided and discussed. The future of therapeutic apheresis and its role in different diseases is undergoing continuous re-evaluation as disease pathogenesis is better understood and new treatment options become available.
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Affiliation(s)
- Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
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16
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Shallis RM, Stahl M, Bewersdorf JP, Hendrickson JE, Zeidan AM. Leukocytapheresis for patients with acute myeloid leukemia presenting with hyperleukocytosis and leukostasis: a contemporary appraisal of outcomes and benefits. Expert Rev Hematol 2020; 13:489-499. [PMID: 32248712 DOI: 10.1080/17474086.2020.1751609] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Hyperleukocytosis, defined as a total white blood cell count (WBC) >50 or more commonly >100 × 109 cells/L, is a presenting feature of acute myeloid leukemia (AML) in about 6-20% of cases and is associated with a higher risk of tumor lysis syndrome (TLS), disseminated intravascular coagulation (DIC), clinical leukostasis with end organ damage, and mortality.Areas covered: In this review, authors discuss the implications of hyperleukocytosis in AML and the current understanding of cytoreductive strategies with a focus on the use of leukocytapheresis.Expert commentary: Efforts to rapidly reduce peripheral myeloblasts have included the use of leukocytapheresis. Early studies demonstrated feasibility in reducing peripheral WBC and blast counts as well as clinically relevant patient outcomes which prompted its common use for many years. However, more recent data have directly challenged the previously touted reports of reduced TLS and DIC incidence as well as survival benefit, even in patients with clinical leukostasis. The use of leukocytapheresis remains highly controversial with wide practice variations among physicians, institutions, and countries given the lack of high-quality data, risks associated with leukocytapheresis itself, associated high costs, resource utilization, and lack of evidence-based clinical guidelines.
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Affiliation(s)
- Rory M Shallis
- Division of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Maximilian Stahl
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jan Philipp Bewersdorf
- Division of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeanne E Hendrickson
- Departments of Laboratory Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Amer M Zeidan
- Division of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
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17
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Management of hyperleukocytosis and impact of leukapheresis among patients with acute myeloid leukemia (AML) on short- and long-term clinical outcomes: a large, retrospective, multicenter, international study. Leukemia 2020; 34:3149-3160. [PMID: 32132655 PMCID: PMC8155811 DOI: 10.1038/s41375-020-0783-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 01/20/2023]
Abstract
Hyperleukocytosis in acute myeloid leukemia (AML) is associated with inferior outcomes. There is limited high quality evidence to support the benefits of leukapheresis. We retrospectively collected data from patients with newly-diagnosed AML who presented with a white cell count (WBC) >50×109/L to 12 centers in the United States and Europe from 2006–2017 and received intensive chemotherapy. Logistic regression models estimated odds ratios for 30-day mortality and achievement of composite complete remission (CRc). Cox proportional hazard models estimated hazard ratios for overall survival (OS). Among 779 patients, clinical leukostasis was reported in 27%, and leukapheresis was used in 113 patients (15%). Thirty-day mortality was 16.7% (95%CI:13.9–19.3%). Median OS was 12.6 months (95%CI:11.5–14.9) among all patients, and 4.5 months (95%CI: 2.7–7.1) among those ≥65 years. Use of leukapheresis did not significantly impact 30-day mortality, achievement of CRc, or OS in multivariate analysis based on available data or in analysis based on multiple imputation. Among patients with investigator-adjudicated clinical leukostasis, there were statistically significant improvements in 30-day mortality and OS with leukapheresis in unadjusted analysis, but not in multivariate analysis. Given the significant resource use, cost, and potential complications of leukapheresis, randomized studies are needed to evaluate its value.
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18
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Liu CJ, Hong YC, Kuan AS, Yeh CM, Tsai CK, Liu YC, Hsiao LT, Wang HY, Ko PS, Chen PM, Liu JH, Gau JP. The risk of early mortality in elderly patients with newly diagnosed acute myeloid leukemia. Cancer Med 2020; 9:1572-1580. [PMID: 31902138 PMCID: PMC7013048 DOI: 10.1002/cam4.2740] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/01/2019] [Accepted: 11/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is a common hematologic neoplasm with high incidence and mortality in the elderly. Our aims were to explore risk factors for early mortality in elderly AML patients and develop a new prognostic score. Methods We enrolled newly diagnosed AML patients age 60 and above at Taipei Veterans General Hospital between July 2008 and May 2017. The primary endpoint was early mortality, defined as death within two months after AML diagnosis. A multivariate Cox proportional hazards model was used to build a risk‐scoring system incorporating significant risk factors for AML. Results The final cohort included 277 elderly AML patients. The median age was 74 (range 60‐96), and 61.7% were male. The two‐month mortality rate was 29.9%. Age ≥ 80 (adjusted HR 1.88), myocardial infarction (adjusted HR 1.87), ECOG ≥ 2 (adjusted HR 2.10), complex karyotype (adjusted HR 3.21), bone marrow blasts ≥ 70% (adjusted HR 1.88), WBC ≥ 100 × 109/L (adjusted HR 3.31), and estimated glomerular filtration rate (eGFR) < 45 (adjusted HR 2.60) were identified as independent predictors for early mortality in the multivariate analysis. A simplified score incorporating the seven factors was developed with good predictive ability measured by Harrell's C statistic [0.72 (95% CI 0.66‐0.78)]. Conclusions We identified seven potential risk factors for early mortality and built up a new prognostic score for elderly AML patients. The new score may help clinicians stratify patients and initiate appropriate management. Further validation of our findings on other cohorts is warranted.
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Affiliation(s)
- Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chung Hong
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ai Seon Kuan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Division of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Kuang Tsai
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Yuan Wang
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Shen Ko
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Min Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan.,Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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19
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Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34:171-354. [PMID: 31180581 DOI: 10.1002/jca.21705] [Citation(s) in RCA: 747] [Impact Index Per Article: 149.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
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Affiliation(s)
- Anand Padmanabhan
- Medical Sciences Institute & Blood Research Institute, Versiti & Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance & University of Washington, Seattle, Washington
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany & First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Erin Meyer
- Department of Hematology/Oncology/BMT/Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks NW & Department of Laboratory Medicine, University of Washington, Seattle, Washington, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Intracranial Hemorrhage in Childhood Acute Leukemia: Incidence, Characteristics, and Contributing Factors. Pediatr Neurol 2019; 99:23-30. [PMID: 31326259 DOI: 10.1016/j.pediatrneurol.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Among all cancers, hematologic malignancy has the highest rate of intracranial hemorrhage. However, there are limited data on intracranial hemorrhage in childhood acute leukemia. We aimed to determine the incidence, characteristics, and factors associated with intracranial hemorrhage in children with acute leukemia. METHODS We reviewed a database of patients aged one month to 15 years diagnosed with acute leukemia during 2003 to 2016 at a hospital in Thailand. Characteristics of patients with intracranial hemorrhage were compared with those of patients without intracranial hemorrhage. Multiple logistic regression was used to determine the associated factors. We performed survival analyses to compare survival and hazard ratios between groups. RESULTS There were 494 children with acute leukemia (acute lymphoblastic leukemia 367, acute myelogenous leukemia 127). Median age was 4.9 years (interquartile range 3.0 to 9.2). Follow-up duration was 2.1 years. Intracranial hemorrhage occurred in 12 patients whose median age was 12.5 years (interquartile range 7.5 to 13.3). Incidence rate of intracranial hemorrhage was 6.2 (acute lymphoblastic leukemia 5.1, acute myelogenous leukemia 12.9) per 1000 person-years. Case fatality rate of intracranial hemorrhage was 75%. Patients with early intracranial hemorrhage had prolonged international normalized ratio and higher white blood cell count, whereas patients with late intracranial hemorrhage had more concurrent systemic infections. Most cases of intracranial hemorrhage were intraparenchymal with perihematomal edema. Median survival was 24 days in the intracranial hemorrhage group compared with four years in the non-intracranial hemorrhage group. Risk of death from intracranial hemorrhage was 3.2 times higher than that of the non-intracranial hemorrhage group. Age at diagnosis, initial white blood cell count, and lactate dehydrogenase were associated with increased risk of intracranial hemorrhage. CONCLUSIONS Intracranial hemorrhage was common and often fatal in children with acute leukemia. Potential contributing factors differed by intracranial hemorrhage timing. Older age, white blood cell count, and lactate dehydrogenase were associated with high risk of intracranial hemorrhage.
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21
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Cohn CS, Allen ES, Cushing MM, Dunbar NM, Friedman DF, Goel R, Harm SK, Heddle N, Hopkins CK, Klapper E, Perumbeti A, Ramsey G, Raval JS, Schwartz J, Shaz BH, Spinella PC, Pagano MB. Critical developments of 2018: A review of the literature from selected topics in transfusion. A committee report from the AABB's Clinical Transfusion Medicine Committee. Transfusion 2019; 59:2733-2748. [PMID: 31148175 DOI: 10.1111/trf.15348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine. An abridged version of this work is being made available in TRANSFUSION, with the full-length report available as Appendix S1 (available as supporting information in the online version of this paper). STUDY DESIGN AND METHODS Papers published in late 2017 and 2018 are included, as well as earlier papers cited for background. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are covered: "big data" and "omics" studies, emerging infections and testing, platelet transfusion and pathogen reduction, transfusion therapy and coagulation, transfusion approach to hemorrhagic shock and mass casualties, therapeutic apheresis, and chimeric antigen receptor T-cell therapy. CONCLUSION This synopsis may be a useful educational tool.
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Affiliation(s)
- Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth S Allen
- Department of Pathology, University of California, San Diego, California
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David F Friedman
- Blood Bank and Transfusion Medicine Department, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruchika Goel
- Division of Transfusion Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Mississippi Valley Regional Blood Center, Springfield, Illinois
| | - Sarak K Harm
- University of Vermont Medical Center, Burlington, VT
| | - Nancy Heddle
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | | | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ajay Perumbeti
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University, and, New York, New York
| | | | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University in St Louis School of Medicine, Saint Louis, Missouri
| | - Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
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Abstract
Cancer continues to be a leading cause of death despite a broader understanding of its biology and the development of novel therapies. Nonetheless, with an increasing survival of this population, intensivists must be aware of the associated emergencies, both old and new. Oncologic emergencies can be seen as an initial presentation of the disease or precipitated by its treatment. In this review, we present key oncologic emergencies that may be encountered in daily practice, complications associated with innovative therapies, and treatment-related adverse events.
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Affiliation(s)
- Krishna Thandra
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zuhair Salah
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sanjay Chawla
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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24
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Korkmaz S. The management of hyperleukocytosis in 2017: Do we still need leukapheresis? Transfus Apher Sci 2018; 57:4-7. [DOI: 10.1016/j.transci.2018.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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25
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Panch SR, Klein HG. Hemapheresis. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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26
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Allogeneic Hematopoietic Stem Cell Transplantation In Therapy-Related Myeloid Neoplasms (t-MN) of the Adult: Monocentric Observational Study and Review of the Literature. Mediterr J Hematol Infect Dis 2018; 10:e2018005. [PMID: 29326802 PMCID: PMC5760063 DOI: 10.4084/mjhid.2018.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023] Open
Abstract
Background Therapy related myeloid neoplasms (t-MN) occur due to direct mutational events of chemotherapeutic agents and radiotherapy. Disease latency, mutational events and prognosis vary with drugs categories. Methods We describe a cohort of 30 patients, 18 females and 12 males, with median age of 52.5 years (range, 20 to 64), submitted to allogeneic stem cell transplantation (HSCT) in our department between September 1999 and March 2017. Patients had a history of solid tumour in 14 cases, haematological disease in 15 cases and both of them in one case. After a median of 36.5 months (range, 4 to 190) from first neoplasm, patients developed t-AML in 19 cases and t-MDS in 11 cases. Molecular abnormalities were detected in 5 patients, while karyotype aberrations were found in 17 patients. Patients received conventional chemotherapy in 14 cases, azacitidine in 10 cases and both of them in one case. Five patients were submitted to HSCT without previous treatment except for supportive therapy. Results Seventeen patients obtained sustained CR after SCT, while 8 patients showed resistant or relapsed disease. The remaining five patients died early after SCT. At follow up time (May 2017) 13 patients were alive with a median OS of 48 months (range 3–195), while 17 patients died after a median of 4 months (range 1–27) by relapse mortality in 6 cases and non-relapse mortality in the other 11 patients. Conclusions Global OS was 43%. After SCT, 72.2% of patients with t-MN maintained a sustained CR.
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27
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Malkan UY, Ozcebe OI. Leukapheresis do not improve early death rates in acute myeloid leukemia patients with hyperleukocytosis. Transfus Apher Sci 2017; 56:880-882. [DOI: 10.1016/j.transci.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/23/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
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28
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Tendulkar AA, Jain PA, Gupta A, Sharma N, Navkudkar A, Patle V. Therapeutic leukocyte reduction for acute and chronic myeloid leukemias: A 4-year experience from an oncology center in India. Asian J Transfus Sci 2017; 11:156-161. [PMID: 28970685 PMCID: PMC5613424 DOI: 10.4103/ajts.ajts_103_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hyperleukocytosis (HL) and leukostasis seen in myeloid leukemias are a medical emergency. We present a case series of ten such patients in a 4-year period. Sixteen therapeutic leukocyte reduction (TLR) were done in ten cases along with other supportive measures. The American Society for Apheresis supports the routine implementation of TLR in cases of HL secondary to myeloid leukemias with signs of leukostasis. MATERIALS AND METHODS The procedures were performed on the intermittent flow cell separator after discussion with the treating physician about patient's condition. Clinical, demographic, analytical, and technical variables were reviewed retrospectively and the patients were followed up at the end of 4 years. Descriptive analysis was performed for all variables, and relationships between quantitative variables and categorical variables were determined by applying the Student's t-test. RESULTS The mean age of presentation was 34 years. Priapism was the most common symptom followed by respiratory distress and neurological disturbances. After an average of 1.6 TLR procedures, the mean leukocyte count reduction achieved was 39.9% along with symptomatic relief. The mean survival at 4-year follow-up was 12.8 months and the overall mortality was 20%. Acute myeloid leukemia patients presented with lower mean platelet counts compared to chronic myeloid leukemia patients; however, the platelet loss in the final product was minimized. CONCLUSION TLR is a safe and effective therapy for leukoreduction in hematological malignancies in our experience.
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Affiliation(s)
- Anita A Tendulkar
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Puneet A Jain
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhaykumar Gupta
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nidhi Sharma
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anisha Navkudkar
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijaya Patle
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
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29
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Choi MH, Choe YH, Park Y, Nah H, Kim S, Jeong SH, Kim HO. The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis: a propensity score-matched study. Transfusion 2017; 58:208-216. [DOI: 10.1111/trf.14329] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Min Hyuk Choi
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
- Department of Laboratory Medicine; National Health Insurance Service Ilsan Hospital; Goyang Korea
| | - Yeon Hwa Choe
- Internal Medicine; Yonsei University College of Medicine; Seoul Korea
| | - Yongjung Park
- Department of Laboratory Medicine; National Health Insurance Service Ilsan Hospital; Goyang Korea
| | - Hyunjin Nah
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
| | - Sinyoung Kim
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
| | - Seok Hoon Jeong
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
| | - Hyun Ok Kim
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
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30
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Zeller B, Glosli H, Forestier E, Ha SY, Jahnukainen K, Jónsson ÓG, Lausen B, Palle J, Hasle H, Abrahamsson J. Hyperleucocytosis in paediatric acute myeloid leukaemia - the challenge of white blood cell counts above 200 × 109
/l. The NOPHO experience 1984-2014. Br J Haematol 2017; 178:448-456. [DOI: 10.1111/bjh.14692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/02/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Bernward Zeller
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
| | - Heidi Glosli
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
| | - Erik Forestier
- Department of Medical Biosciences, Genetics; Umeå University Hospital; Umeå Sweden
| | - Shau-Yin Ha
- Department of Paediatrics and Adolescent Medicine; Queen Mary Hospital and Hong Kong Paediatric Haematology & Oncology Study Group (HKPHOSG); Hong Kong China
| | - Kirsi Jahnukainen
- Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Ólafur G. Jónsson
- Department of Paediatrics; Landspitali University Hospital; Reykjavík Iceland
| | - Birgitte Lausen
- Department of Paediatrics and Adolescent Medicine; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Josefine Palle
- Department of Woman′s and Children′s Health; Uppsala University; Uppsala Sweden
| | - Henrik Hasle
- Department of Paediatrics; Aarhus University Hospital Skejby; Aarhus Denmark
| | - Jonas Abrahamsson
- Department of Paediatrics; Institution for Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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31
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Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, Dunbar NM, Witt V, Wu Y, Shaz BH. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher 2017; 31:149-62. [PMID: 27322218 DOI: 10.1002/jca.21470] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Anand Padmanabhan
- Blood Center of Wisconsin, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance and University of Washington, Seattle, Washington
| | - Meghan Delaney
- Bloodworks Northwest, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks Northwest, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Beth H Shaz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.,New York Blood Center, Department of Pathology.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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32
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Nan X, Qin Q, Gentille C, Ensor J, Leveque C, Pingali SR, Phan AT, Rice L, Iyer S. Leukapheresis reduces 4-week mortality in acute myeloid leukemia patients with hyperleukocytosis – a retrospective study from a tertiary center. Leuk Lymphoma 2017; 58:1-11. [DOI: 10.1080/10428194.2016.1277386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Xinyu Nan
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Qian Qin
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Cesar Gentille
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Joe Ensor
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
| | - Christopher Leveque
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Sai R. Pingali
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
| | - Alexandria T. Phan
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
| | - Lawrence Rice
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Swaminathan Iyer
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
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33
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Giammarco S, Chiusolo P, Piccirillo N, Di Giovanni A, Metafuni E, Laurenti L, Sica S, Pagano L. Hyperleukocytosis and leukostasis: management of a medical emergency. Expert Rev Hematol 2016; 10:147-154. [DOI: 10.1080/17474086.2017.1270754] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sabrina Giammarco
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Chiusolo
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Piccirillo
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Alessia Di Giovanni
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Metafuni
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Laurenti
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Sica
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Livio Pagano
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
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34
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Nguyen R, Jeha S, Zhou Y, Cao X, Cheng C, Bhojwani D, Campbell P, Howard SC, Rubnitz J, Ribeiro RC, Sandlund JT, Gruber T, Inaba H, Pui CH, Metzger ML. The Role of Leukapheresis in the Current Management of Hyperleukocytosis in Newly Diagnosed Childhood Acute Lymphoblastic Leukemia. Pediatr Blood Cancer 2016; 63:1546-51. [PMID: 27187265 PMCID: PMC5131872 DOI: 10.1002/pbc.26056] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 03/21/2016] [Accepted: 04/15/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hyperleukocytosis in children with acute lymphoblastic leukemia (ALL) has been associated with early morbidity and mortality. The use of leukapheresis in these children treated with contemporary therapy remains controversial. PROCEDURE We analyzed clinical data from patients enrolled onto frontline protocols for ALL (Total Therapy XV and XVI) between 2003 and 2014. We documented adverse events within the first 14 days in patients with a white blood cell (WBC) count ≥200 × 10(9) /l and reviewed their management. RESULTS Fifty-three (7.8%) of 678 consecutive pediatric patients with newly diagnosed ALL presented with hyperleukocytosis (median WBC count 393 × 10(9) /l; range 200-1,014). Two deaths in patients without initial hyperleukocytosis occurred within the first 2 weeks from diagnosis secondary to bacterial sepsis. A total of 21 (40%) patients with ALL and hyperleukocytosis developed grade 3 or 4 adverse events regardless of the use of leukapheresis (P > 0.99 and P = 0.19). Sixteen of 53 (30%) patients with ALL received low-dose chemotherapy for leukocytoreduction initially. One-third of patients received urate oxidase, and none of the patients with hyperleukocytosis required hemodialysis. CONCLUSIONS The early morbidity and mortality commonly associated with hyperleukocytosis in children with newly diagnosed ALL can be avoided with contemporary supportive care and conservative management possibly obviating the need for costly and potentially dangerous leukapheresis.
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Affiliation(s)
- Rosa Nguyen
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Sima Jeha
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Yinmei Zhou
- Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Xueyuan Cao
- Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Deepa Bhojwani
- Department of Pediatrics, Children’s Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 9002
| | - Patrick Campbell
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Scott C. Howard
- School of Health Studies, University of Memphis, Memphis, TN, 38152, USA
| | - Jeffrey Rubnitz
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - John T. Sandlund
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Tanja Gruber
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Monika L. Metzger
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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35
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Ichikawa K, Edahiro Y, Gotoh A, Iiduka K, Komatsu N, Koike M. Co-occurrence of hyperleukocytosis and elevated fibrin-fibrinogen degradation product levels is a risk factor for early intracranial hemorrhage in patients with de novo acute leukemia. Int J Hematol 2016; 104:612-620. [PMID: 27456463 DOI: 10.1007/s12185-016-2072-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022]
Abstract
Early intracranial hemorrhage (eICH) is a potentially fatal complication of acute leukemia. We analyzed risk factors for eICH in patients with de novo acute leukemia. Ninety-one de novo acute leukemia patients at our institution between September 2003 and June 2014 were included. Of the 91 patients, eight (8.8 %) and 83 were included in the eICH and non-eICH groups, respectively. Univariate analysis demonstrated that white blood cell (WBC) count (P = 0.018), fibrin-fibrinogen degradation product (FDP) level (P = 0.0075), co-occurrence of WBC ≥50,000/µl and FDP level >40 µg/ml (P < 0.001), and fever (P = 0.248) were all significant predictors of eICH at the 0.25 level. In a subsequent multivariate analysis involving these parameters, only the combination of hyperleukocytosis and elevated FDP levels was found to be significant at the 0.05 level. A significant difference in the duration of the overall survival (OS) period was detected between patients that did and did not exhibit the combination of hyperleukocytosis and elevated FDP levels (P < 0.001). Co-occurrence of hyperleukocytosis and elevated FDP levels is a significant risk factor for eICH in patients with de novo acute leukemia and has a significant adverse affect on OS.
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Affiliation(s)
- Kunimoto Ichikawa
- Sakura Life Clinic, ABY Building 1F, 4-12-10, Ishihara, Sumida-ward, Tokyo, 130-0011, Japan.
| | - Yoko Edahiro
- Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihiko Gotoh
- Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuhide Iiduka
- Department of Hematology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Norio Komatsu
- Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Michiaki Koike
- Department of Hematology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
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36
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Acute Disseminated Encephalomyelitis. J Clin Apher 2016; 31:163-202. [PMID: 27322219 DOI: 10.1002/jca.21474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Creutzig U, Rössig C, Dworzak M, Stary J, von Stackelberg A, Wössmann W, Zimmermann M, Reinhardt D. Exchange Transfusion and Leukapheresis in Pediatric Patients with AML With High Risk of Early Death by Bleeding and Leukostasis. Pediatr Blood Cancer 2016; 63:640-5. [PMID: 26670831 DOI: 10.1002/pbc.25855] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/21/2015] [Accepted: 11/04/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The risk of early death (ED) by bleeding/leukostasis is high in patients with AML with hyperleukocytosis (>100,000/μl). Within the pediatric AML-BFM (Berlin-Frankfurt-Münster) 98/04 studies, emergency strategies for these children included exchange transfusion (ET) or leukapheresis (LPh). Risk factors for ED and interventions performed were analyzed. PATIENTS Two hundred thirty-eight of 1,251 (19%) patients with AML presented with hyperleukocytosis; 23 of 1,251 (1.8%) patients died of bleeding/leukostasis. RESULTS ED due to bleeding/leukostasis was highest at white blood cell (WBC) count >200,000/μl (14.3%). ED rates were even higher (20%) in patients with FAB (French-American-British) M4/M5 and hyperleukocytosis >200,000/μl. Patients with WBC >200,000/μl did slightly better with ET/LPh compared to those without ET/LPh (ED rate 7.5% vs. 21.2%, P = 0.055). Multivariate WBC >200,000/μl was of strongest prognostic significance for ED (P(χ(2) ) <0.0001). CONCLUSION Our data confirm the high risk of bleeding/leukostasis in patients with hyperleukocytosis. ET/LPh shows a trend toward reduced ED rate due to bleeding/leukostasis and is recommended at WBC >200,000/μl, and in FAB M4/M5 even at lower WBC.
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Affiliation(s)
- Ursula Creutzig
- Department of Pediatric Hematology and Oncology Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Claudia Rössig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Michael Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Arend von Stackelberg
- Department of Pediatric Oncology/Hematology, Charité University Medical Center Berlin, Berlin, Germany
| | - Wilhelm Wössmann
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Dirk Reinhardt
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
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38
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Mamez AC, Raffoux E, Chevret S, Lemiale V, Boissel N, Canet E, Schlemmer B, Dombret H, Azoulay E, Lengliné E. Pre-treatment with oral hydroxyurea prior to intensive chemotherapy improves early survival of patients with high hyperleukocytosis in acute myeloid leukemia. Leuk Lymphoma 2016; 57:2281-8. [PMID: 26849624 DOI: 10.3109/10428194.2016.1142083] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute myeloid leukemia with high white blood cell count (WBC) is a medical emergency. A reduction of tumor burden with hydroxyurea may prevent life-threatening complications induced by straight chemotherapy. To evaluate this strategy, we reviewed medical charts of adult patients admitted to our institution from 1997 to 2011 with non-promyelocytic AML and WBC over 50 G/L. One hundred and sixty patients were included with a median WBC of 120 G/L (range 50-450), 107 patients received hydroxyurea prior to chemotherapy, and 53 received emergency induction chemotherapy (CT). Hospital mortality was lower for patients treated with hydroxyurea (34% versus 19%, p = 0.047) even after adjusting for age (p < 0.01) and initial WBC count (p = 0.02). No evidence of any difference between treatment groups in terms of WBC decline kinetics and disease free survival (p = 0.87) was found. Oral hydroxyurea prior to chemotherapy seems a safe and efficient strategy to reduce early death of hyperleukocytic AML patients.
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Affiliation(s)
- Anne-Claire Mamez
- a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France
| | - Emmanuel Raffoux
- b Department of Hematology , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;,c EA-3518, Institut Universitaire D'hématologie Université Paris Diderot , Paris , France
| | - Sylvie Chevret
- d Biostatistic Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;,e ECSTRA Team, CRESS (UMR 1153), Inserm , Université Paris Diderot , Paris , France
| | - Virginie Lemiale
- a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France
| | - Nicolas Boissel
- b Department of Hematology , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;,c EA-3518, Institut Universitaire D'hématologie Université Paris Diderot , Paris , France
| | - Emmanuel Canet
- a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;,e ECSTRA Team, CRESS (UMR 1153), Inserm , Université Paris Diderot , Paris , France
| | - Benoît Schlemmer
- a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France
| | - Hervé Dombret
- b Department of Hematology , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;,c EA-3518, Institut Universitaire D'hématologie Université Paris Diderot , Paris , France
| | - Elie Azoulay
- a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;,e ECSTRA Team, CRESS (UMR 1153), Inserm , Université Paris Diderot , Paris , France
| | - Etienne Lengliné
- a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;,b Department of Hematology , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;,c EA-3518, Institut Universitaire D'hématologie Université Paris Diderot , Paris , France
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39
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Berber I, Kuku I, Erkurt MA, Kaya E, Gozukara Bag H, Nizam I, Koroglu M, Ozgul M, Bazna S. Leukapheresis in acute myeloid leukemia patients with hyperleukocytosis: A single center experience. Transfus Apher Sci 2015; 53:185-90. [DOI: 10.1016/j.transci.2015.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
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40
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Hahn AW, Jamy O, Nunnery S, Yaghmour G, Giri S, Pathak R, Martin MG. How Center Volumes Affect Early Outcomes in Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:646-54. [PMID: 26386907 DOI: 10.1016/j.clml.2015.07.646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/28/2015] [Accepted: 07/28/2015] [Indexed: 01/28/2023]
Abstract
Early mortality (EM) is all too frequent during induction chemotherapy for acute myeloid leukemia. Older patients shoulder an undue amount of this burden as a result of the inherent biology of their disease and increased comorbidities. EM rates in academic centers have seen a sharp decline over the past 20 years; however, data from population-based registries show that EM rates for the general population have significantly lagged behind. In this review, we analyze the data available on EM in academic centers and the general population, explore recent improvements in supportive care and the use of predictive models, and finally investigate the relationship between case volume and complications during chemotherapy.
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Affiliation(s)
- Andrew W Hahn
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN.
| | - Omer Jamy
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Sara Nunnery
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - George Yaghmour
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN; Department of Hematology/Oncology, The West Cancer Center, Memphis, TN
| | - Smith Giri
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Ranjan Pathak
- Department of Internal Medicine, Reading Health System, West Reading, PA
| | - Mike G Martin
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN; Department of Hematology/Oncology, The West Cancer Center, Memphis, TN
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41
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Howell C, Douglas K, Cho G, El-Ghariani K, Taylor P, Potok D, Rintala T, Watkins S. Guideline on the clinical use of apheresis procedures for the treatment of patients and collection of cellular therapy products. Transfus Med 2015; 25:57-78. [PMID: 26013470 DOI: 10.1111/tme.12205] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 01/19/2023]
Affiliation(s)
- C. Howell
- Diagnostic & Therapeutic Services; NHS Blood and Transplant; Bristol UK
| | - K. Douglas
- Beatson West of Scotland Cancer Centre; Glasgow UK
- Scottish National Blood Transfusion Service; Glasgow UK
| | - G. Cho
- London North West Healthcare NHS Trust; Harrow UK
| | - K. El-Ghariani
- Therapeutics & Tissue Services; NHS Blood and Transplant; Sheffield UK
| | - P. Taylor
- The Rotherham NHS Foundation Trust; Rotherham UK
| | - D. Potok
- Diagnostic & Therapeutic Services; NHS Blood and Transplant; Leeds UK
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42
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Berber I, Erkurt MA, Kuku I, Kaya E, Gozukara Bag H, Nizam I, Koroglu M, Yigit A, Ozgul M. Leukapheresis treatment in elderly acute leukemia patients with hyperleukocytosis: A single center experience. J Clin Apher 2015; 31:53-8. [DOI: 10.1002/jca.21402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 04/21/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Ilhami Berber
- Hematology Division; Department of Internal Medicine; Inonu University School of Medicine; Malatya Turkey
| | - Mehmet Ali Erkurt
- Hematology Division; Department of Internal Medicine; Inonu University School of Medicine; Malatya Turkey
| | - Irfan Kuku
- Hematology Division; Department of Internal Medicine; Inonu University School of Medicine; Malatya Turkey
| | - Emin Kaya
- Hematology Division; Department of Internal Medicine; Inonu University School of Medicine; Malatya Turkey
| | - Harika Gozukara Bag
- Department of Biostatistics and Medical Informatics; Inonu University School of Medicine; Malatya Turkey
| | - Ilknur Nizam
- Hematology Division; Department of Internal Medicine; Inonu University School of Medicine; Malatya Turkey
| | - Mustafa Koroglu
- Hematology Division; Department of Internal Medicine; Inonu University School of Medicine; Malatya Turkey
| | - Ali Yigit
- Department of Internal Medicine; Inonu University School of Medicine; Malatya Turkey
| | - Mustafa Ozgul
- Hematology Division; Department of Internal Medicine; Inonu University School of Medicine; Malatya Turkey
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How I treat hyperleukocytosis in acute myeloid leukemia. Blood 2015; 125:3246-52. [DOI: 10.1182/blood-2014-10-551507] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/02/2015] [Indexed: 12/18/2022] Open
Abstract
Abstract
Hyperleukocytosis (HL) per se is a laboratory abnormality, commonly defined by a white blood cell count >100 000/µL, caused by leukemic cell proliferation. Not the high blood count itself, but complications such as leukostasis, tumor lysis syndrome, and disseminated intravascular coagulation put the patient at risk and require therapeutic intervention. The risk of complications is higher in acute than in chronic leukemias, and particularly leukostasis occurs more often in acute myeloid leukemia (AML) for several reasons. Only a small proportion of AML patients present with HL, but these patients have a particularly dismal prognosis because of (1) a higher risk of early death resulting from HL complications; and (2) a higher probability of relapse and death in the long run. Whereas initial high blood counts and high lactate dehydrogenase as an indicator for high proliferation are part of prognostic scores guiding risk-adapted consolidation strategies, HL at initial diagnosis must be considered a hematologic emergency and requires rapid action of the admitting physician in order to prevent early death.
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Abstract
Abstract
Patients presenting with new or recurrent acute leukemia, particularly of the myeloid lineage, with WBC counts exceeding 100 × 109/L are often considered for leukocytapheresis, especially if they are experiencing symptoms of leukostasis. These symptoms are thought to occur because of blast aggregates and WBC thrombi in the circulation, which reduce blood flow. Leukostasis may cause various complications, including hyperviscosity syndrome, vascular occlusion resulting in intracranial hemorrhages and respiratory failure, and perivascular leukemic infiltrates. Leukostasis occurs more commonly with a high WBC count and with leukemias of monocytoid lineage such as acute myelomonocytic leukemia, which is a reflection of the nature of the leukemic blasts. Leukocytapheresis is used in an effort to quickly decrease a patient's circulating blast count, which can both prevent the development of leukostasis and provide symptomatic relief of leukostasis. However, the impact of leukocytapheresis on early- and long-term mortality is controversial, with several studies producing conflicting results. In this chapter, the pathophysiology of leukostasis, performance of leukocytapheresis, and efficacy of this treatment are reviewed.
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Daver N, Kantarjian H, Marcucci G, Pierce S, Brandt M, Dinardo C, Pemmaraju N, Garcia-Manero G, O'Brien S, Ferrajoli A, Verstovsek S, Popat U, Hosing C, Anderlini P, Borthakur G, Kadia T, Cortes J, Ravandi F. Clinical characteristics and outcomes in patients with acute promyelocytic leukaemia and hyperleucocytosis. Br J Haematol 2014; 168:646-53. [PMID: 25312977 DOI: 10.1111/bjh.13189] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/07/2014] [Indexed: 01/20/2023]
Abstract
The clinical characteristics, treatment options and outcomes in patients with acute promyelocytic leukaemia (APL) and hyperleucocytosis remain poorly defined. This study reviewed 242 consecutive patients with APL; 29 patients (12%) had a white blood cell count (WBC) ≥ 50 × 10(9) /l at presentation (median WBC 85·5 × 10(9) /l). Patients with hyperleucocytosis had inferior complete remission (CR) rates (69% vs. 88%; P = 0·004) and higher 4-week mortality (24% vs. 9%; P = 0·018) compared to patients without hyperleucocytosis. We noted a trend towards inferior 3-year disease-free survival (DFS) (69% vs. 80%; P = 0·057) and inferior 3-year overall survival (OS) (74% vs. 92%; P = 0·2) for patients with hyperleucocytosis. Leukapheresis was performed in 11 (38%) of the 29 patients with hyperleucocytosis. CR rate and 3-year OS were not significantly improved in patients who received leukapheresis. CR rate and 3-year OS for the 15 patients with hyperleucocytosis treated with all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO) plus cytotoxic therapy (idarubicin or gemtuzumab ozogamicin) combinations were 100% and 100% vs. 57% and 35% for the 14 patients treated with non-ATRA/ATO combinations (P = 0·004 and P = 0·002). Leukapheresis does not improve the outcomes in patients with APL presenting with hyperleucocytosis. ATRA/ATO-based combinations are superior to other regimens in these patients.
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Affiliation(s)
- Naval Daver
- Departments of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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46
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Kuo KHM, Callum JL, Panzarella T, Jacks LM, Brandwein J, Crump M, Curtis JE, Gupta V, Lipton JH, Minden MD, Sher GD, Schimmer AD, Schuh AC, Yee KWL, Keating A, Messner HA. A retrospective observational study of leucoreductive strategies to manage patients with acute myeloid leukaemia presenting with hyperleucocytosis. Br J Haematol 2014; 168:384-94. [DOI: 10.1111/bjh.13146] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 07/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin H. M. Kuo
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Jeannie L. Callum
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Tony Panzarella
- Biostatistics Department; Princess Margaret Hospital; Toronto ON Canada
| | - Lindsay M. Jacks
- ErinoakKids Centre for Treatment and Development; Mississauga ON Canada
| | - Joseph Brandwein
- Division of Hematology; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Michael Crump
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - John E. Curtis
- London Regional Cancer Program; London Health Sciences Centre; London Canada
| | - Vikas Gupta
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Jeffrey H. Lipton
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Mark D. Minden
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | | | - Aaron D. Schimmer
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Andre C. Schuh
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Karen W. L. Yee
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Armand Keating
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
| | - Hans A. Messner
- Division of Medical Oncology and Hematology; Princess Margaret Hospital; University Health Network; Toronto ON Canada
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Scott KM, Gardner FP, Eidelman BH, Rivera CE, Menke DM, Barrett KM. Clinical reasoning: a 69-year-old man with leukocytosis and hemorrhagic brain lesions. Neurology 2014; 83:e1-5. [PMID: 24982042 DOI: 10.1212/wnl.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kristin M Scott
- From the Departments of Neurology (K.M.S., B.H.E., K.M.B.), Hematology/Oncology (F.P.G., C.E.R.), and Pathology (D.M.M.), Mayo Clinic Florida, Jacksonville
| | - Faithlore P Gardner
- From the Departments of Neurology (K.M.S., B.H.E., K.M.B.), Hematology/Oncology (F.P.G., C.E.R.), and Pathology (D.M.M.), Mayo Clinic Florida, Jacksonville
| | - Benjamin H Eidelman
- From the Departments of Neurology (K.M.S., B.H.E., K.M.B.), Hematology/Oncology (F.P.G., C.E.R.), and Pathology (D.M.M.), Mayo Clinic Florida, Jacksonville
| | - Candido E Rivera
- From the Departments of Neurology (K.M.S., B.H.E., K.M.B.), Hematology/Oncology (F.P.G., C.E.R.), and Pathology (D.M.M.), Mayo Clinic Florida, Jacksonville
| | - David M Menke
- From the Departments of Neurology (K.M.S., B.H.E., K.M.B.), Hematology/Oncology (F.P.G., C.E.R.), and Pathology (D.M.M.), Mayo Clinic Florida, Jacksonville
| | - Kevin M Barrett
- From the Departments of Neurology (K.M.S., B.H.E., K.M.B.), Hematology/Oncology (F.P.G., C.E.R.), and Pathology (D.M.M.), Mayo Clinic Florida, Jacksonville.
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Therapeutic leukapheresis: 9-year experience in a University Hospital. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:46-52. [PMID: 24960648 DOI: 10.2450/2014.0310-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/29/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hyperleucocytosis is associated with higher morbidity and mortality related to possible development of leucostasis, tumour lysis syndrome and/or disseminated intravascular coagulation. There is insufficient evidence of the need for leukocytapheresis during early treatment of hyperleucocytosis, and its efficiency remains controversial, although leucoreduction is a measure that can prevent adverse events and death. The aim of this study was to analyse the safety and effectiveness of therapeutic leukocytapheresis and its influence on early mortality in our case series, adjusted to independent mortality risk factors described in the literature. MATERIALS AND METHODS This was a retrospective review (June 2003-June 2012) of procedures carried out for the treatment of hyperleucocytosis at the Haematology and Haemotherapy Service of Miguel Servet University Hospital. The patients' data and technical information were prospectively registered for each leukocytapheresis session. RESULTS Thirteen patients underwent a total of 27 leukocytapheresis procedures. After an average of two sessions, a statistically significant drop in the initial leucocyte counts was observed (p<0.01), as well as a relevant drop in lactate dehydrogenase levels. The only analytical value statistically related to early mortality in univariate analysis was initial creatinine level greater than 1.2 mg/dL (p=0.012, OR=2.5). DISCUSSION Despite the small size and limited homogeneity of our case series, we can conclude that leukocytapheresis is a safe and effective therapeutic measure for leucoreduction in haematological pathologies of any lineage, particularly in patients without acute myeloid leukaemia. Patients with acute myeloid leukaemia had worse outcomes within 6 months of having finished leukocytapheresis sessions, as well as in terms of mean global survival and mean time of mortality. However, global mortality rates were similar in patients with or without acute myeloid leukaemia.
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49
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Yilmaz D, Karapinar B, Karadaş N, Duyu M, Yazici P, Ay Y, Balkan C, Aydinok Y, Kavakli K. Leukapheresis in childhood acute leukemias: single-center experience. Pediatr Hematol Oncol 2014; 31:318-26. [PMID: 23988130 DOI: 10.3109/08880018.2013.818747] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hyperleukocytosis in patients with leukemia is associated with early mortality, especially due to the pulmonary and neurological complications of leukostasis. The prompt use of leukapheresis may improve patients' survival in the initial treatment period. The medical records of all previously untreated acute leukemia patients were reviewed to determine whether there was hyperleukocytosis at presentation. This study summarizes a single-center experience of leukapheresis that was applied to 12 children with acute leukemia and hyperleukocytosis. The median leukocyte count at diagnosis was 589,000/mm(3) (range: 389,000-942,000/mm(3)) for ALL patients and 232,000/mm(3) (range: 200,000-282,000/mm(3)) for AML patients. A central venous catheter (CVC) was inserted, and leukapheresis procedures were repeated at 12-hour intervals. A total of 29 leukapheresis cycles were performed on 12 children. The median number of cycles of leukapheresis required by each patient was two (range: 1-4). The median absolute and percentage reductions in white blood cell (WBC) count after the first cycle of leukapheresis were 113,000/mm(3) (range: 55,000-442,000/mm(3)) and 36% (range: 16-57.4%), respectively. As a laboratory finding, mild hypocalcemia was the most frequently observed complication. No patients developed any other problem related to the procedure. Our results showed that leukapheresis is a safe and effective procedure if performed by experienced staff.
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Affiliation(s)
- Deniz Yilmaz
- Department of Pediatric Hematology, Ege University Faculty of Medicine , Bornova, Izmir , Turkey
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50
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Abstract
The occurrence of hyperleukocytosis (leukocytes > 100.000/μl) is associated with complications such as leukostasis, tumor lysis and consumption coagulopathy in patients with acute leukemia much more often than in patients with chronic malignant hematological diseases. To manage these situations may be complex as organ failure is often imminent or manifest, infectious complications arise and indications for induction chemotherapy are usually urgent. Prophylaxis and therapy of the tumor lysis syndrome consists of hydration, lowering of uric acid and the management of electrolyte disturbances. Leukostasis requires immediate reduction of the leukocyte count by leukapheresis, administration of hydroxycarbamide and, ultimately, by causative and specific treatment of the underlying disease itself. In patients with curable diseases or favorable long-term prognosis, transfer to the intensive care unit must be evaluated early in the course of impending organ dysfunction, especially in cases of acute respiratory failure.
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