The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis: a propensity score‐matched study

Choi, Min Hyuk; Choe, Yeon Hwa; Park, Yongjung; Nah, Hyunjin; Kim, Sinyoung; Jeong, Seok Hoon; Kim, Hyun Ok

doi:10.1111/trf.14329

Cited by 41 publications

(46 citation statements)

References 38 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%

“…In seven studies, all patients had a WBC of greater than 100 × 10 9 /L on presentation independent of whether they subsequently underwent leukapheresis. 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).…”

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%

“…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. [17][18][19]21,23,24 Among these studies leukapheresis was stopped once the WBC dropped below 100 × 10 9 /L 17,23 or after clinical improvement 18,23 in two studies each. Three studies did not specify the criteria for discontinuation of leukapheresis.…”

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%

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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: Treatment Characteristicsmentioning

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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Clinical characteristics and outcomes of children with newly diagnosed acute myeloid leukemia and hyperleukocytosis managed with different cytoreductive methods

Christakopoulos

Walker

Smith

et al. 2023

Cancer

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Background: Hyperleukocytosis in patients with acute myeloid leukemia (AML) has been associated with worse outcomes. For cytoreduction, leukapheresis has been used but its clinical utility is unknown, and low-dose cytarabine (LD-cytarabine) is used as an alternative method. Methods:Children with newly diagnosed AML treated between 1997 and 2017 in institutional protocols were studied. Hyperleukocytosis was defined as a leukocyte count of ≥100 � 10 9 /L at diagnosis. Clinical characteristics, early complications, survival data, and effects of cytoreductive methods were reviewed. Among 324 children with newly diagnosed AML, 49 (15.1%) presented with hyperleukocytosis. Initial management of hyperleukocytosis included leukapheresis or exchange transfusion (n = 16, considered as one group), LD-cytarabine (n = 18), hydroxyurea (n = 1), and no leukoreduction (n = 14). Results:Compared with patients who received leukapheresis, the percentage decrease in leukocyte counts following intervention was greater among those who received LD-cytarabine (48% vs. 75%; p = .02), with longer median time from diagnosis to initiation of protocol therapy (28.1 vs. 95.2 hours; p < .001). The incidence of infection was higher in patients (38%) who had leukapheresis than those who receive LD-cytarabine (0%) or leukoreduction with protocol therapy (14%) (p = .008). No differences were noted in the outcomes among the intervention groups. Although patients with hyperleukocytosis had higher incidences of pulmonary and metabolic complications than did those without, no early deaths occurred, and the complete remission, event-free survival, overall survival rates, and outcomes of both groups were similar. Conclusion:LD-cytarabine treatment appears to be a safe and effective means of cytoreduction for children with AML and hyperleukocytosis.

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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

Schwartz

Winters

Padmanabhan

et al. 2019

J of Clinical Apheresis

1,332

1,195

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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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The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis: a propensity score‐matched study

Cited by 41 publications

References 38 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

Clinical characteristics and outcomes of children with newly diagnosed acute myeloid leukemia and hyperleukocytosis managed with different cytoreductive methods

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

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