Complications of “Very High” Leukocytosis in Pediatric Acute Leukemia Patients Managed Without Rasburicase and Leukopheresis

Abstract

The authors evaluated complications in pediatric acute leukemia with "very high" leukocytosis (VHL) prior to rasburicase availability and without leukopheresis. From Jun 2003 through Dec 2009, 45 out of 457 (10 %) pediatric acute leukemia patients had VHL. Median WBC for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients was 296,500/mm3 (200,000-615,220) and 206,300/mm3 (106,100-541,900) respectively. Laboratory and clinical tumor-lysis-syndrome was seen in 37.7 % and 13.3 % patients respectively; none required dialysis; 6.6 % died due to CNS/pulmonary bleed. Thrombocytopenia <31,000/mm3 was associated with hypocalcemia (p = 0.04) and mortality (p = 0.04), and hypoalbuminemia with kidney dysfunction (p = 0.04). In resource-limited setting, VHL patients with thrombocytopenia may warrant rasburicase with or without leukopheresis, and aggressive platelet support.

Low-dose Rasburicase in Hematologic Malignancies

“…Thus in patients with very high PUA (>20 mg/dl) and/or renal failure, it may be prudent to use the 0.2 mg/kg dose to achieve a steep reduction in PUA and quick recovery of renal function. Although rasburicase is very effective in reducing PUA in Indian children, it should be pointed out that many cases of hyperleukocytosis and laboratory TLS can be managed without rasburicase or leukopheresis, as reported by Bakhshi et al [16]. In their retrospective study of 45 patients with hyperleukocytosis (of which 50 % had lab TLS or clinical TLS) treated only with allopurinol and intrevenous fluids, none needed dialysis.…”

“…Median age, 9 y (range, 0. [9][10][11][12][13][14][15][16][17][18][19]. Underlying diagnoses were as follows: T-cell ALL, 19; Pre-B ALL, 17; T-NHL, 2; B-NHL, 2; AML, 1.…”