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

Porcu, Pierluigi; Danielson, Constance; Orazi, Attilio; Heerema, Nyla A.; Gabig, Theodore G.; McCarthy, Leo J.

doi:10.1046/j.1365-2141.1997.1943011.x

Cited by 127 publications

(104 citation statements)

References 11 publications

(13 reference statements)

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“…The efficacy of leukapheresis for patients who already present with severe complications is limited. 24,25 Porcu et al 26 suggest that cerebral infarction and/or hemorrhage are not due to sludging, but rather caused by direct endothelial damage, as a result from migration of leukemic cells into the perivascular spaces. Other measures Table 3 Overview of the rates of death other than progressive leukemia for the respective DCOG ALL and AML protocols a Protocol ALL-6 included nonhigh-risk patients only, whereas protocols ALL-7 and eight included all patients with ALL.…”

Section: Discussionmentioning

confidence: 99%

Causes of death – other than progressive leukemia – in childhood acute lymphoblastic (ALL) and myeloid leukemia (AML): the Dutch Childhood Oncology Group experience

et al. 2005

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We analyzed causes of death, other than resistant disease or relapse, in 875 children with acute lymphoblastic leukemia (ALL) and 229 with acute myeloid leukemia (AML), treated on three different Dutch Childhood Oncology Group (DCOG) ALL and three AML protocols. Overall, 23 (2.6%) ALL and 44 (19.2%) AML patients died. Early death (ED, before remission was reached) occurred in nine ALL (1%) and thirty AML (13.1.%) patients, including three and ten deaths before treatment was initiated. Chemotherapy-related mortality in remission (CRM) occurred in nine ALL (1.1%) and eight AML (4.4%) patients. For ALL, both ED and CRM declined over time, although this was not statistically significant. For AML a decrease in ED was observed (from 26% to approximately 10%), but counterbalanced by an increase in CRM (from 3 to 8%), maybe related to the scheduling of intensification blocks in AML-92/94. Including transplant-related mortality, death in CR rates in AML increased from 3 to 15% in the last study. The main cause of ED was hemorrhage, often associated with hyperleucocytosis, and infection for CRM. We conclude that mortality dropped favorably in ALL, but not in AML. Especially for AML, effective but less toxic therapy and better supportive care guidelines need to be developed.

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Section: Discussionmentioning

confidence: 99%

Causes of death – other than progressive leukemia – in childhood acute lymphoblastic (ALL) and myeloid leukemia (AML): the Dutch Childhood Oncology Group experience

et al. 2005

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“…[4][5][6][7] A study in 1997 demonstrated that 27.1% of adult patients died within 1 week of treatment. 9 Recent studies have had better survival rates; early death occurred in only 5.6% of adult patients and in 9.9% of pediatric patients. 2,20 In our study, the incidence of early death decreased dramatically in the contemporary AML protocols (22.8% vs 2.7%), although the incidence of early complications did not differ.…”

Section: -7mentioning

confidence: 99%

“…8 However, a recent study of an adult cohort failed to demonstrate that leukapheresis is associated with an improved early mortality rate. 9 To our knowledge, no recently published study has evaluated the clinical course and management of AML and hyperleukocytosis in pediatric patients. For the current study, we evaluated the medical records of 579 patients who were treated on 9 consecutive institutional AML protocols 10 and studied the clinical and biologic features of 106 pediatric patients with AML and hyperleukocytosis.…”

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confidence: 99%

Clinical and biologic features and treatment outcome of children with newly diagnosed acute myeloid leukemia and hyperleukocytosis

Inaba

Fan

Pounds

et al. 2008

Cancer

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BACKGROUND.Acute myeloid leukemia (AML) with hyperleukocytosis often is associated with early complications. To the authors' knowledge, no recently published study has evaluated the management and clinical course in this regard, especially in relation to pediatric patients.METHODS.The authors reviewed 579 patients with newly diagnosed pediatric AML who were treated at St. Jude Children's Research Hospital from 1968 to 2002 and carefully examined 106 patients with initial leukocyte counts ≥100 ×109/L and French‐American‐British (FAB) AML subtypes other than M3. These patients with hyperleukocytosis were divided into 2 groups—‘before’ (early period; 70 patients) and ‘after’ (late period; 36 patients) the initiation of the AML‐83 protocol—to address potential differences in supportive measures (including leukoreduction).RESULTS.Forty‐five patients (42.5%) had early complications that were associated strongly with M4 and M5 FAB subtypes and had higher initial leukocyte counts than the patients without complications. Early deaths were less common in the late period (2.8%) than in the early period (22.9%; P = .01), although the incidence of early complications was similar. The late period was associated with a shorter time for referral (P = .0018), a longer time from admission to chemotherapy initiation (P < .0001), and lower white blood cell counts at chemotherapy initiation (P < .0001). In the late period, patients with or without hyperleukocytosis had similar complete remission rates. However, those with hyperleukocytosis had a lower postremission 10‐year event‐free survival rate (21.2% vs 41.7%; P = .0228).CONCLUSIONS.With improved management, including supportive care, early mortality in patients with AML and hyperleukocytosis decreased remarkably in the more recent period. However, better postremission treatment is required to improve long‐term survival. Cancer 2008. © 2008 American Cancer Society.

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“…21 Several studies have evaluated the impact on morbidity and mortality of the use of leukocytapheresis in the treatment of acute leukemias, but have yielded conflicting results. 1,17,[22][23][24][25] For example, Giles et al 22 published a retrospective study of 146 patients with newly diagnosed AML, of whom 71 underwent leukocytapheresis. Although the 2-week mortality rate was reduced in leukocytapheresis patients, there was no effect on long-term survival.…”

Section: Efficacymentioning

confidence: 99%

Leukocytapheresis for the treatment of hyperleukocytosis secondary to acute leukemia

Aqui

O’Doherty

2014

Hematology

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Patients presenting with new or recurrent acute leukemia, particularly of the myeloid lineage, with WBC counts exceeding 100 ϫ 10 9 /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. Learning Objective• To gain an understanding of the pathophysiology of leukostasis and the role of leukocytapheresis as a therapeutic invention

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

Cited by 127 publications

References 11 publications

Causes of death – other than progressive leukemia – in childhood acute lymphoblastic (ALL) and myeloid leukemia (AML): the Dutch Childhood Oncology Group experience

Causes of death – other than progressive leukemia – in childhood acute lymphoblastic (ALL) and myeloid leukemia (AML): the Dutch Childhood Oncology Group experience

Clinical and biologic features and treatment outcome of children with newly diagnosed acute myeloid leukemia and hyperleukocytosis

Leukocytapheresis for the treatment of hyperleukocytosis secondary to acute leukemia

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