Patterns of care and clinical outcomes of patients with newly diagnosed acute myeloid leukemia presenting with hyperleukocytosis who do not receive intensive chemotherapy

Shallis, Rory M.; Stahl, Maximilian; Wei, Wei; Montesinos, Pau; Lengliné, Etienne; Neukirchen, Judith; Bhatt, Vijaya Raj; Sekeres, Mikkael A.; Fathi, Amir T.; König, Heiko; Luger, Selina M.; Khan, Irum; Roboz, Gail J.; Cluzeau, Thomas; Martínez‐Cuadrón, David; Raffoux, Emmanuel; Germing, Ulrich; Umakanthan, Jayadev Manikkam; Mukhereje, Sudipto; Brunner, Andrew M.; Miller, Adam; McMahon, Christine M.; Ritchie, Ellen K.; Rodríguez‐Veiga, Rebeca; Itzykson, Raphaël; Boluda, Blanca; Rabian, Florence; Tormo, Mar; Acuña‐Cruz, Evelyn; Rabinovich, Emma; Yoo, Brendan; Cano, Isabel; Podoltsev, Nikolai A.; Bewersdorf, Jan Philipp; Gore, Steven D.; Zeidan, Amer M.

doi:10.1080/10428194.2020.1728753

Cited by 17 publications

(25 citation statements)

References 16 publications

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“…Studies included were published between 1988 and 2020 and conducted in Europe, Asia, and North America. 5,6,[17][18][19][20][21][22][23][24][25][26][27] Four studies used various approaches to match baseline patient and disease characteristics between the two groups to reduce the potential influence of selection bias, 18,22,23,25 with two of those studies using propensity score matching. 18,25 The decision regarding which patients should undergo leukapheresis was driven by department policies, 18,23 the discretion of the treating physician, 5,19,20,22 or a combination of both 17,21,24 in two, four, and three studies, respectively.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

“…5,17,18,21,24,26,27 Baseline cytogenetic risk and presence of selected somatic mutations were reported by four and two studies, respectively. 6,17,23,25 Patients who underwent leukapheresis appeared to be younger (mean median age, 56.6 years vs 59.8 years) and to have had higher WBC counts (mean median WBC, 180.9 × 10 9 /L vs 137.1 × 10 9 /L) than patients who were not treated with leukapheresis, respectively ( Table 1). A formal statistical comparison was not feasible, since measures of dispersion of age and WBC counts (standard deviation or interquartile range) were not consistently reported across studies and a pooled sample variance could not be generated.…”

Section: Baseline Patient Characteristicsmentioning

confidence: 99%

“…In six studies, all patients received intensive chemotherapy in both the leukapheresis and nonleukapheresis groups, 5,18,19,[24][25][26] while no patient in the study by Shallis et al 6 received intensive chemotherapy. In all studies that reported the number of leukapheresis sessions per patient, patients underwent a median of one leukapheresis procedure with a maximum of three to five sessions in individual studies.…”

Section: Treatment Characteristicsmentioning

confidence: 99%

“…Due to the observational retrospective study design, the quality of evidence based on GRADE approach was low. Additionally, eight, 5,6,17,[19][20][21]24,26 one, 27 and four studies 18,22,23,25 were deemed to be at high, unknown, and low risk of bias, respectively (Table S2).…”

Section: Treatment Characteristicsmentioning

confidence: 99%

“…[1][2][3] Mortality rates as high as 8% and 29% within 24-hour and 1-week periods, respectively, have been reported. [4][5][6] Therefore, hyperleukocytosis constitutes a hematologic emergency, and emergent cytoreduction is often indicated. The high early mortality rate in patients with hyperleukocytosis has been attributed to the greater frequency of leukostasis, disseminated intravascular coagulation (DIC), and tumor lysis syndrome (TLS).…”

Section: Introductionmentioning

confidence: 99%

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Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia—A systematic review and meta‐analysis

et al. 2020

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Background: Up to 20% of patients with acute myeloid leukemia (AML) present with hyperleukocytosis, usually defined as a white blood cell (WBC) count greater than 100 × 10 9 /L. Given the high early mortality rate, emergent cytoreduction with either leukapheresis, hydroxyurea, or chemotherapy is indicated, but the optimal strategy is unknown. Study Design and Methods: For this systematic review and meta-analysis we searched MEDLINE and EMBASE via Ovid, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from inception through March 2020 for multiarm studies comparing early mortality rates of patients with AML treated with leukapheresis and those who were not. The risk ratio (RR) of early death for patients who received leukapheresis vs patients who did not was estimated using a sum of the log-ratio of individual study estimates weighted by sample size. Results: Among 13 two-arm, retrospective studies with 1743 patients (486 leukapheresis and 1257 nonleukapheresis patients), leukapheresis did not improve the primary outcome of early mortality compared to treatment strategies in which leukapheresis was not used (RR, 0.88; 95% confidence interval [CI], 0.69-1.13; P = .321) without statistically significant heterogeneity between studies (Cochranʼs Q, 18; P = .115; I 2 , 33.4%). Patients presenting with clinical leukostasis tended to be more likely to undergo leukapheresis (odds ratio, 2.01; 95% CI, 0.99-4.08; P = .052). Conclusion: As we did not find evidence of a short-term mortality benefit and considering the associated complications and logistic burden, our results argue against the routine use of leukapheresis for hyperleukocytosis among patients with AML.

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Section: Description Of Included Studiesmentioning

confidence: 99%

Section: Baseline Patient Characteristicsmentioning

confidence: 99%

Section: Treatment Characteristicsmentioning

confidence: 99%

Section: Treatment Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia—A systematic review and meta‐analysis

et al. 2020

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Effectiveness of leukapheresis on early survival in acute myeloid leukemia: An observational propensity score matching cohort study

Lee,

Han,

Kim

et al. 2023

J of Clinical Apheresis

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BackgroundThe association between leukapheresis (LK) as a treatment option for hyperleukocytosis (HL) in patients with acute myeloid leukemia (AML) remains controversial.MethodsData were extracted from the electronic medical record for 2801 patients with AML between April 2009 and December 2019. LK was performed when the leukocyte count was ≥100 × 109/L at the time initial bone marrow examination.ResultsA comparison between the patients with HL in the non‐LK (n = 1579) and LK (n = 208) groups revealed survival probabilities (%) of 93.2% and 90.4% (P = .130) for day 30 (D30), 85.4% and 84.2% (P = .196) for D60, and 83.6% and 80.8% (P = .258) for D90, respectively. After propensity score matching, a comparison between the patients with HL in the non‐LK (n = 192) and LK (n = 192) groups revealed survival probabilities (%) of 83.9% and 91.2% (P = .030) for D30, 75.0% and 84.9% (P = .015) for day 60 (D60), and 62.4% and 81.3% (P = .034) for day 90 (D90), respectively. After D150, the observed effect of LK appeared to be mitigated without a survival benefit.DiscussionLK was associated with improved early survival outcomes at D30, D60, and D90 among patients with AML exhibiting HL. Thus, it may be considered a treatment option for reducing cell mass in such patients.

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Take a spin: Apheresis in the care of adult leukaemia patients

2023

Best Practice & Research Clinical Haematology

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Patterns of care and clinical outcomes of patients with newly diagnosed acute myeloid leukemia presenting with hyperleukocytosis who do not receive intensive chemotherapy

Cited by 17 publications

References 16 publications

Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia—A systematic review and meta‐analysis

Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia—A systematic review and meta‐analysis

Effectiveness of leukapheresis on early survival in acute myeloid leukemia: An observational propensity score matching cohort study

Take a spin: Apheresis in the care of adult leukaemia patients

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