Rapid cytoreduction in childhood leukemic hyperleukocytosis by conservative therapy

Abstract

Childhood leukemic hyperleukocytosis poses a serious threat to life because of its associated metabolic complications. The present prospective trial utilized conservative management of childhood acute lymphoblastic leukemia with hyperleukocytosis (total white cell count equal or > 100 x 10(9)/L) by intravenous hydration, urinary alkalinization, and allopurinol presenting without severe life-threatening complications. The median reduction in WBC count was 81.51% (range: 66-98.8%) within a median period of 36 hours (range: 12-60 hours) following hospitalization. There were no failures or treatment related complications. Thus we conclude that in childhood acute lymphoblastic leukemia, hyperleukocytosis can be managed safely and effectively with intravenous hydration, urinary alkalinization, and allopurinol before starting any specific anti-leukemic chemotherapy avoiding risk-associated cranial irradiation, leukapheresis, and exchange transfusion.

Management of Hyperleukocytosis and Prevention of Tumor Lysis Syndrome with Low-Dose Prednisone Continuous Infusion in Children with Acute Lymphoblastic Leukemia

“…Although there are no evidence-based guidelines for when to start leukapheresis, it is usually started in the presence of symptoms of leukostasis, irrespective of the blast count [15, 16]. In ALL, leukapheresis is usually not done unless symptoms of leukostasis develop or the blast count exceeds 100–200 × 10 9 /l [6,17,18,19]. A single session of leukapheresis decreases the white blood cell count by 20–50%.…”

“…Exchange transfusion is particularly preferred in little children, but because of contamination and transfusion-related complications its application has been reduced recently [5, 18, 20]. Cytoreduction procedures are commonly recommended for patients with hyperleukocytosis based on case reports or retrospective studies [21,22,23].…”

Therapeutic leukapheresis in hyperleucocytic leukaemias: lack of correlation between degree of cytoreduction and early mortality rate

“…However, there is still no convincing evidence that leukapheresis is essential in the immediate treatment of HL. Moreover, despite proven cytoreductive capability, leukapheresis is an invasive procedure requiring central vascular access and experienced personnel, prompting some to pursue a more conservative approach in children (Ablin, 1984;Nelson et al, 1993;Basade et al, 1995). To investigate the impact of leukapheresis on early mortality, we report our experience with 48 consecutive HL patients treated by immediate leucocytoreduction.…”

Profile and Outcome of Hyperleukocytosis in Childhood Acute Lymphoblastic Leukemia: Experience From a Tertiary Center in India

“…In a study on 178 ALL patients with hyperleukocytosis, Lowe et al (2005) found renal derangements in 5% (9/178) of the patients, with about half of these (4 patients, 2.2%) requiring dialysis [9] . In a previous study on an Indian pediatric ALL population, Basade et al found deranged kidney function in 44% (5 of 9 patients) [10] . We encountered a lower percentage of renally impaired patients, and none require dialysis.…”

“…There was one mortality during the initial induction phase (4.2%). Previously, many researchers including Lowe et al, Castagnetti et al (2008), Nelson et al (1997) and Basade et al (1995), have found conservative cytoreduction to yield effective decline in WBC count and prevention of leukostatic or hemorrhagic complications [9,10,13,14] .…”