Childhood acute lymphoblastic leukemia with hyperleukocytosis at presentation

Kong, Seom Gim; Seo, Jung Ho; Jun, So Eun; Lee, Byung Ki; Lim, Young Tak

doi:10.5045/br.2014.49.1.29

Cited by 25 publications

(48 citation statements)

References 19 publications

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“…The incidence of hyperleukocytosis and subject characteristics in this study were similar to others, in terms of sex, mean age, and presence of lymphoid infiltration. 10,12,14 Male sex and lymphoid infiltration had significant associations with hyperleukocytosis. 10,15,16 In addition, the age group of 1-10 years had a significant association with the incidence of WBC count > 200 x 10 9 /L.…”

Section: Discussionmentioning

confidence: 98%

“…10,12,14 Male sex and lymphoid infiltration had significant associations with hyperleukocytosis. 10,15,16 In addition, the age group of 1-10 years had a significant association with the incidence of WBC count > 200 x 10 9 /L. 10 The differences in our study from other studies were imunophenotype B-cell as the most common immunophenotype and only a few patients had symptoms of TLS.…”

Section: Discussionmentioning

confidence: 98%

“…13 The survival analysis was conducted for two WBC groups: those with 50-200 x 10 9 /L and those with > 200 x 10 9 /L, following the studies already done. 10,12 Potential prognostic factors were analyzed by bivariate with Cox regression model; variables with P values < 0.25 at univariate analysis were included…”

Section: Methodsmentioning

confidence: 99%

“…Some studies revealed that hyperleukocytosis increased the risk of poor outcomes by 12 times, including high relapse and mortality rates and low survival rate. 10,13 The poor outcome such as relapse rate was significantly correlated with high leukocyte count. The WBC of > 300 x 10 9 /L resulted in shorter survival, highest relapse rate, and highest mortality rate caused by chemotherapy.…”

mentioning

confidence: 99%

“…9 The most common complications are metabolic, such as hyperphosphatemia, hypocalcemia, hyperkalemia, hyperuricemia, and hemodialysis (33.3%), as well as neurological effects, such as seizures, bleeding, and respiratory complications in 8.3%. 10 Hyperleukocytosis complications lead to a high mortality rate of 20% and a low event-free survival rate of 63.3% vs. 100% for >100 x 10 9 /L vs. < 100 x 109/L. 11,12 The prognosis of childhood ALL with hyperleukocytosis worse than those without hyperleukocytosis.…”

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confidence: 99%

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The outcomes of childhood acute lymphoblastic leukemia with hyperleukocytosis

Alfina

Widjajanto

Patria

2018

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Background Hyperleukocytosis in childhood acute lymphoblastic leukemia (ALL) is an emergency in oncology. This condition showed high mortality and relapse rates, as well as low survival rate. The outcomes of this group of patients are not yet well studied. Objective To evaluate the characteristics and outcomes of childhood acute lymphoblastic leukemia (ALL) with hyperleukocytosis. Methods This was a retrospective cohort study. The patients were children less than 18 year of age who were diagnosed as ALL in Dr. Sardjito Hospital, Yogyakarta, from January 1st 2010 to November, 30th 2016. Event-free survival rate and overall survival rate were estimated for group of patients with the white blood cell (WBC) groups 50-200x109/L and >200x109/L using the Kaplan-Meier method. Results There were 705 children diagnosed as ALL during the study period, 129 (18%) with hyperleukocytosis and 111 of them met the inclusion criteria, consisted of 76 children in a group of WBC 50-200 x 109/L and 35 children in a group of WBC >200 x 109/L. Presentation at diagnosis: median age were 7 years (range 1 month-18 years), male was 1.5 higher than female, 92% of cases with lymphoid infiltration, 5% with CNS involvement, 40% had bleeding tendency, and 10% had clinical tumor lysis syndrome (TLS). Median WBC was 122 (range 53.4-876) x 109/L; mean Hb was 8 (SD 3) g/dL; median platelet count was 30 (range 1-221) x 109/L. Immunophenotyping was done in 23 patients, 5/23 (8%) was T cell. The patients in lower WBC group showed lower death (26% vs. 34%, P=0,389), higher two-year event-free survival (EFS) 68% vs. 45%, P=0.003, and overall survival (77% vs. 68%, P= 0.16), compared to patients in higher WBC group. Univariate and multivariate Cox regression analyses revealed that none of the variables was a significant prognostic factor for 2 years EFS or overall survival. Conclusion The group of children with ALL and hyperleukocytosis with lower WBC at diagnoses showed better outcomes than the higher WBC.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The outcomes of childhood acute lymphoblastic leukemia with hyperleukocytosis

Alfina

Widjajanto

Patria

2018

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Outcomes of children and young adults with T‐cell acute lymphoblastic leukemia/lymphoma who present in critical status

Wayne¹,

Chung

et al. 2022

Pediatric Blood & Cancer

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Background Patients with T‐cell acute lymphoblastic leukemia and lymphoma (T‐ALL/LLy) commonly present with critical features such as hyperleukocytosis and mediastinal mass, which complicates completing a diagnostic and staging workup and prevents clinical trial enrollment. Procedure Consecutive patients with T‐ALL/LLy from 1999 to 2019 at the Children's Hospital of Philadelphia were analyzed for pediatric intensive care unit (PICU) admission and various high‐risk features as well as clinical trial enrollment and outcome. Results We identified 153 patients newly diagnosed with T‐ALL/LLy, 53 (35%) required PICU‐level care within 24 hours and 73 (48%) within 7 days. Non‐PICU patients had a significantly higher clinical trial enrollment rate (79.4%) versus PICU patients (56.1%, P = 0.016). Patients who enrolled on a clinical trial had similar relapse risk to those who did not enroll (relapse rate 20% vs 29%, P = 0.523). Nineteen patients were precluded from trial participation. Risk of relapse was increased for patients admitted to the PICU within 24 hours (26% vs 13%, P = 0.048). Forty‐four patients with T‐ALL presented with hyperleukocytosis, of which 30% relapsed versus 14% without (P = 0.082). Patients who underwent apheresis for hyperleukocytosis were statistically more likely to relapse (47% vs 15%, P = 0.007). Patients with elevated uric acid (20% vs 16%, P = 0.278), mediastinal mass (20% vs 14%, P = 0.501), or required emergent steroids (20% vs 16%, P = 0.626) had a similar relapse risk. A single second relapse patient survived. Conclusions Almost half of T‐ALL/LLy patients required PICU‐level care at diagnosis, making enrollment on clinical trials challenging, but trial enrollment predicted better outcome. Physicians should balance maintaining eligibility with safety to offer patients all options.

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MR imaging findings in some rare neurological complications of paediatric cancer

et al. 2018

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Neurological complications of paediatric cancers are a substantial problem. Complications can be primary from central nervous system (CNS) spread or secondary from indirect or remote effects of cancer, as well as cancer treatments such as chemotherapy and radiation therapy. In this review, we present the clinical and imaging findings of rare but important neurological complications in paediatric patients with cancer. Neurological complications are classified into three phases: pre-treatment, treatment and post-remission. Paraneoplastic neurological syndromes, hyperviscosity syndrome, haemophagocytic lymphohistiocytosis and infection are found in the pre-treatment phase, while Trousseau’s syndrome, posterior reversible encephalopathy syndrome and methotrexate neurotoxicity are found in the treatment phase; though some complications overlap between the pre-treatment and treatment phases. Hippocampal sclerosis, radiation induced tumour, radiation induced focal haemosiderin deposition and radiation-induced white matter injury are found in the post-remission phase. With increasingly long survival after treatment, CNS complications have become more common. It is critical for radiologists to recognise neurological complications related to paediatric cancer or treatment. Magnetic resonance imaging (MRI) plays a significant role in the recognition and proper management of the neurological complications of paediatric cancer.Teaching Points• Neurological complications of paediatric cancer include various entities.• Neurological complications are classified into three phases: pre-treatment, treatment and post-remission.• Radiologists should be familiar with clinical and imaging findings of neurological complications.• MRI features may be characteristic and lead to early diagnosis and proper treatments.

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Childhood acute lymphoblastic leukemia with hyperleukocytosis at presentation

Cited by 25 publications

References 19 publications

The outcomes of childhood acute lymphoblastic leukemia with hyperleukocytosis

The outcomes of childhood acute lymphoblastic leukemia with hyperleukocytosis

Outcomes of children and young adults with T‐cell acute lymphoblastic leukemia/lymphoma who present in critical status

MR imaging findings in some rare neurological complications of paediatric cancer

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