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

Christakopoulos, Georgios E.; Walker, Kendra N.; Smith, Jesse; Takemoto, Clifford M.; Yan, Zheng; Pui, Ching‐Hon; Ribeiro, Raul C.; Wang, Lei; Pounds, Stanley; Rubnitz, Jeffrey E.; Inaba, Hiroto

doi:10.1002/cncr.34751

Cited by 3 publications

References 31 publications

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Management of hyperleukocytosis and results of leukapheresis in childhood acute leukemia: A single center experience and review of the literature

TERZİ,

Ayçiçek,

Uysalol

et al. 2023

Preprint

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Background Hyperleukocytosis in pediatric acute leukemia is associated with increased morbidity/mortality and there is no consensus on the use of leukapheresis(LP) for its management.The aim was to review patients' clinical characteristics and outcomes with newly diagnosed leukemia with hyperleukocytosis(HL). Methods A retrospective case control study reviewed data from a single institution over a 5-year period.Hyperleukocytosis was present in 41 patients with acute leukemia and were included in the study.Treatment strategies included hyperhydration, administration of allopurinol or rasbirucase, early induction of induction chemotherapy(CT), and LP. Results Twenty seven (65.9%) of the 41 patients were male and the median age was 7(range 1–17) years.LP was used in 9 of 41 (13%) patients with hyperleukocytosis and a total of 25 LP procedures were performed.The mean leukocyte value after apheresis was 65,529/mm3.In patients with and without LP, tumor lysis syndrome was seen in 2(23%) and 2(6.25%) patients, respectively.Pulmonary leukostasis was seen in 2 patients, one of whom underwent LP.The mean leukocyte count in patients who received LP versus those who did not was 520.000 cells/mm3 and 158.800 cells/mm3, respectively(p = 0.01).The time from presentation to the initiation of CT was the same between those who received LP and those who did not (mean of 17h and 18h) (p > 0.05).During the first 30 days after presentation, cerebral leukostasis/coagulopathy or pulmonary leukostasis-related early death did not occur in patients with leukemia. Conclusions The use of LP in patients with hyperleukocytosis is safe and effective.

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Management of hyperleukocytosis and results of leukapheresis in childhood acute leukemia: A single center experience and review of the literature

TERZİ,

Ayçiçek,

Uysalol

et al. 2023

Preprint

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Leukomoid Reaction and Partial Exchange in an Infant with Pertussis

Talay,

Orhan,

Demirbuğa

2024

Int J Infect

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Introduction: Leukemoid reactions resulting from infections other than leukemia can present with serious clinical conditions. Pertussis infection, particularly before vaccination, can lead to severe pneumonia and may trigger a leukemoid reaction. This case is presented to highlight the relationship between severe pneumonia and leukemoid reaction in pertussis. Case Presentation: A 41-day-old baby girl, who had not yet been vaccinated against pertussis, was hospitalized in the pediatric intensive care unit with a diagnosis of severe pneumonia due to pertussis infection and required mechanical ventilation. A pronounced leukemoid reaction (144,000 cells/μL) was observed. Despite hydration and supportive treatment, a partial exchange was performed due to the elevated white blood cell count. Although there was partial improvement in the white blood cell count, the patient passed away on the 11th day of follow-up. Conclusions: There is a need for further case reports to determine the appropriate timing for initiating partial exchange treatment and the number of cycles required.

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Leukapheresis in Pediatric Acute Leukemia with Hyperleukocytosis: A Single Center Experience

TERZİ,

Aycicek,

Pasli Uysalol

et al. 2024

Iran J Pediatr

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Background: Hyperleukocytosis (HL) in pediatric acute leukemia is associated with increased morbidity and mortality. The indications for leukapheresis (LPH) in these patients remain unclear, and the use of LPH remains controversial. Objectives: This study aimed to review the clinical characteristics and outcomes of newly diagnosed leukemia patients with HL, comparing those who received LPH and those who did not. Methods: We analyzed clinical data from patients enrolled in frontline protocols for acute leukemia between 2017 and 2022. We documented adverse events within the first 30 days in patients with a white blood cell (WBC) count ≥ 100,000 cells/mm³ and reviewed their management. Treatment strategies included hyperhydration, administration of allopurinol or rasburicase, early induction chemotherapy (CT), and LPH. Results: Of 404 pediatric patients with newly diagnosed acute leukemia, 41 (10.1%) presented with HL (median WBC count: 136,000 cells/mm³; range HL: 101,000 - 844,000 cells/mm³). Leukapheresis was used in 9 of the 41 (13%) patients with HL. The median WBC count in patients who received LPH was 520,000 cells/mm³ compared to 158,800 cells/mm³ in those who did not (P = 0.01). Pulmonary leukostasis occurred in 2 patients, one of whom underwent LPH. No early deaths related to cerebral leukostasis, coagulopathy, or pulmonary leukostasis were observed in any patient within the first 30 days. The LPH procedure was well tolerated, with no reported complications. The time from presentation to the initiation of CT was similar between patients who received LPH and those who did not, with a mean of 17 hours versus 18 hours, respectively (P > 0.05). Tumor lysis syndrome (clinical or laboratory) was observed in 2 patients (23%) with LPH and 2 patients (6.25%) without LPH. Conclusions: The early morbidity and mortality often associated with HL in children with newly diagnosed acute leukemia can be avoided through conservative management, potentially reducing the need for LPH. However, LPH is a safe and well-tolerated procedure at our institution. It may be considered for patients with leukostasis when early induction CT is not feasible.

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

Cited by 3 publications

References 31 publications

Management of hyperleukocytosis and results of leukapheresis in childhood acute leukemia: A single center experience and review of the literature

Management of hyperleukocytosis and results of leukapheresis in childhood acute leukemia: A single center experience and review of the literature

Leukomoid Reaction and Partial Exchange in an Infant with Pertussis

Leukapheresis in Pediatric Acute Leukemia with Hyperleukocytosis: A Single Center Experience

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