Therapeutic leukocyte reduction for acute and chronic myeloid leukemias: A 4-year experience from an oncology center in India

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.

The value of leukapheresis for treatment of priapism as presenting feature of chronic myeloid leukemia—Case report and review of literature

“…In a study by Tendulkar et al. [65], leukapheresis was found to be adequate in lowering leukocyte count, with an average of 1.6 sessions needed. Despite the favorable response in Jandial et al., long duration of symptoms and high leukocyte counts may have contributed to ischemic priapism and severe ED.…”

“…However, we state that the disadvantages do not outweigh the benefits of leukapheresis. Leukapheresis can decrease leukocyte count rapidly in approximately 1.6 sessions, and minimize complications caused by hyperviscosity and leukocyte aggregation in microcirculations [65]. Secondly, leukapheresis could decrease the occurrence of tumor‐lysis syndrome in leukemia patients [81].…”

“…Tendulkar [65] 2017 Retrospectively leukapheresis carried out over 4 years, in patients with leukocyte count >100 × 10 9 and with symptoms of leukostasis. With a mean age of 34 years.…”

“…All patients received cytoreductive therapy (hydroxycarbamide and Imatinib), additionally 21 patients underwent aspiration, 13 patients therapeutic leukapheresis, and eight patients shunt surgery. ED could be assessed in 14 patients at follow-up, occurrence and severity of ED were unaffected by leukapheresis or shunt surgery.In a study by Tendulkar et al[65], leukapheresis was found to be adequate in lowering leukocyte count, with an average of 1.6 sessionsTA B L E 4 Baseline characteristics and outcomes of included patients, divided by treatment strategiesOncologic…”

Therapeutic apheresis and non‐blood donor related apheresis current practices at various blood centres of healthcare organisations of India: A brief online survey

“…The cascade filtration, and extracorporeal photopheresis, were reported only from one blood centre each. The centres from India are increasingly reporting the use of apheresis for ABO‐incompatible solid organ transplant, 17–20 therapeutic cytoreduction, 21,22 peripheral blood stem cell (PBSC) harvest, 23 and regenerative medicine for the establishment of human‐induced pluripotent stem cell lines 24 …”